People with Intellectual Disability have higher incidence of osteoporotic fractures: Lancet

Current osteoporosis guidelines do not identify individuals with intellectual disabilities (ID) as at risk of fracture, potentially missing opportunities for prevention. The researchers conducted a study to assess the incidence of fractures in people with ID over the life course.

The researchers Valeria Frighi and colleagues has found that the frequency, kind, and location of fractures in people with intellectual disability point to early onset of osteoporosis. The findings of this study were published in eClinical Medicine.

There may be missed chances for prevention since current osteoporosis recommendations do not recognize people with intellectual disability (ID) as being at risk of fracture. Researchers conducted this study to determine the prevalence of fractures in people with ID throughout the course of their lives.

Descriptive analysis of an open cohort study utilizing anonymous electronic health information from the Hospital Episode Statistics database and the UK Clinical Practice Research Datalink (Jan 1, 1998–Dec 31, 2017). In order to compare fractures between people with and without ID (age 1–17 and 18 years) for any fracture, and in people aged 18–49 and 50 years for major osteoporotic fracture (vertebra, shoulder, wrist, hip), the incidence rate (95% CI) per 10,000 person-years (py) and incidence rate ratio (IRR, 95% CI) were calculated.

The key findings of this study were:

1. Along with 215733 matched control persons, 43176 individuals with ID were discovered and included (40.4% of them were female).

2. Females had an incidence of any fracture of 143.5 (131.8-156.3) against 120.7 (115.4-126.4)/10000 py for children and 174.2 (166.4-182.4) versus 118.2 (115.3-121.2)/10000 py for adults.

3. IRR for major osteoporotic fracture was 1.81 (1.50-2.18) for those aged 18 to 49 and 1.69 (1.53-1.87) for individuals over 50 in women.

4. For men, it was 1.56 (1.36-1.79) for ages 18 to 49 and 2.45 (2.13-2.81) for ages 50 and beyond. IRR for hip fracture was 7.79 (4.14-14.65) years old for males and 2.28 (1.91-2.71) years old for women for the same age range. It was 6.04 (4.18-8.73) for males aged 18 to 49 and 3.91 (3.17-4.82) for those aged 50 and older.

5. Comparable rates of major osteoporotic fracture and hip fracture occurred in women and men with ID at intervals of 15 and 20 years, respectively, and 30 and 40 years, respectively, sooner than at comparable intervals in the absence of ID.

6. Adults with and without ID had a markedly different fracture distribution, with hip fractures accounting for 9.9% of all fractures and 5.0% of those without.

Reference: 

Frighi, V., Smith, M., Andrews, T. M., Clifton, L., Collins, G. S., Fuller, A., Roast, J., & Holt, T. A. (2022). Incidence of fractures in people with intellectual disabilities over the life course: a retrospective matched cohort study. In eClinicalMedicine (p. 101656). Elsevier BV. https://doi.org/10.1016/j.eclinm.2022.101656