Bone health in adults with non‐ambulatory neuromuscular disorders: scoping review of risk factors, diagnosis and management

BACKGROUND: Non-ambulatory adults have an increased risk of osteoporosis and fractures due to reduced weight-bearing and diminished neuromuscular stimulation, resulting in substantial morbidity and mortality. AIMS: This scoping review aimed to systematically evaluate risk factors, diagnostic indicators and management strategies for optimising bone health in adults with non-ambulatory neuromuscular disorders. METHODS: A structured search was conducted in Scopus, MEDLINE, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, Embase and Web of Science. Inclusion criteria defined adults with non-ambulatory neuromuscular conditions and reported outcomes on bone mineral density (BMD), osteoporosis or fracture incidence. Screening was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-Scoping Review guidelines. RESULTS: Twenty-nine studies met the inclusion criteria. The most significant risk factor associated with bone disease was reduced weight-bearing and immobility, followed by a history of past fractures and wheelchair dependence. Dual-energy X-ray absorptiometry was the primary diagnostic modality to assess BMD, while biochemical markers showed limited diagnostic utility. Management strategies such as neuromuscular electrical stimulation and passive bone loading demonstrated minimal efficacy. Bisphosphonate therapy was supported in specific subgroups, including Duchenne muscular dystrophy and spinal cord injury. No consensus on evidence-based management was identified for the target population. CONCLUSIONS: Current evidence to guide diagnosis and management in this population is limited. Adults with non-ambulatory neuromuscular disorders represent a small, heterogeneous group with variability in disease aetiology, onset, distribution and progression. This is reflected within the sparse literature, making it challenging to stratify risk factors, establish standardised outcome measures and develop robust, evidence-based strategies to improve bone health.