Risk of Osteoporosis-Related Fracture in Children and Adolescents with Intellectual Disability.

Background and

Objectives

Children and adolescents with intellectual disability (ID) experience substantial health disparities, yet their skeletal health has been overlooked. Early-onset osteoporosis and fracture remain underrecognized in this population. Hence, this study assessed the risk of osteoporosis with concomitant fracture in this population using nationwide cohort data. Materials and

Methods

This population-based retrospective cohort study examined data from South Korea's National Health Insurance Service-National Health Information Database (2004-2021). In all, 75,790 individuals with ID and 922,921 control individuals aged 2-18 years were included. The primary outcome was osteoporosis with concomitant fracture occurring within 1 year before or after the osteoporosis diagnosis. The secondary outcome was osteoporosis with a pathological fracture.

Results

The ID group had a significantly higher risk of developing osteoporosis with concomitant fracture than the control group (unadjusted hazard ratio [HR], 6.821; 95% confidence interval [CI], 5.065-9.187; p < 0.001). This association remained significant after adjusting for demographic factors and medical comorbidities as a composite variable (HR, 4.385; 95% CI, 3.080-6.245; p < 0.001) and after additional adjustment for cerebral palsy (HR, 3.331; 95% CI, 2.252-4.926; p < 0.001). Subgroup analyses showed stronger associations in males (HR, 7.597), younger ages (7-11 years: HR, 9.501), and rural areas (HR, 8.882).

Conclusions

Children and adolescents with ID have a high risk of osteoporosis with concomitant fracture. Early assessment and targeted strategies are needed to promote bone health in this population.