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

## TL;DR

Children and teens with intellectual disability face a much higher risk of osteoporosis-related fractures compared to their peers, highlighting the need for early bone health interventions.

## Contribution

This study is the first to use nationwide data to quantify the elevated fracture risk in children and adolescents with intellectual disability.

## Key findings

- Children with ID had a 6.8-fold higher risk of osteoporosis with concomitant fracture compared to controls.
- The risk remained significant even after adjusting for comorbidities and cerebral palsy.
- Higher risks were observed in males, younger children (7–11 years), and those in rural areas.

## Abstract

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.