Age and sex-specific risk in fractures with Down syndrome in a retrospective case-control study from Germany.
Women with Down syndrome over 50 fracture bones twice as often as peers, so start fall-prevention early.
01Research in Context
What this study did
Klein et al. (2024) looked at medical records of German adults with Down syndrome. They matched each adult to a peer without Down syndrome and counted broken bones over five years.
The team wanted to know if age and sex change fracture risk in this population.
What they found
Women with Down syndrome over 50 broke bones about twice as often as their matched peers.
Men with Down syndrome also had more fractures, but the jump came later than in women.
How this fits with other research
Costa et al. (2017) first showed that low bone mass is common in German adults with Down syndrome. Klein et al. (2024) now prove this weaker bone turns into real breaks.
Hagopian et al. (1999) found that women with Down syndrome enter menopause earlier, linking earlier aging to health risks. The new fracture spike right after 50 fits that pattern.
Hamama et al. (2021) saw high fracture rates in institutionalized children with epilepsy and ID. Klein et al. (2024) extend the warning to community-dwelling adults with Down syndrome, showing the risk never goes away.
Why it matters
If you serve adults with Down syndrome, add bone health to the care plan. Screen women at 45 and men at 55, teach fall-proofing at home, and ask doctors about calcium, vitamin D, or bone drugs. A quick balance walk or clutter check during visits can prevent a break later.
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02At a glance
03Original abstract
BACKGROUND: The increasing life expectancy of individuals with Down syndrome has led to a growing awareness of mid- and late-life conditions. METHODS: Based on the Disease Analyser database (IQVIA), this retrospective cohort study compared adults ≥18 years of age with Down syndrome (ICD-10: Q90) in general practices in Germany with a propensity score-matched cohort without Down syndrome. The outcome was the first diagnosis of a fracture within 5 years of the index date. The cumulative incidence of fractures over a 5-year period was presented using Kaplan-Meier curves. Univariable Cox regression analyses by age group and sex were performed to assess the association between Down syndrome and fractures. RESULTS: A total of 2547 individuals with Down syndrome and 12 735 individuals without Down syndrome were included in the study. A significantly higher cumulative fracture incidence within 5 years was observed in the age group 51-60 years (9.3% Down syndrome vs. 4.8% without Down syndrome, P = 0.003) as well as in the age group >60 years (20.3% Down syndrome vs. 8.6% without Down syndrome, P < 0.001) compared with the cohort without Down syndrome. Regression analysis showed a significant association between Down syndrome and fracture risk in women with Down syndrome aged 51-60 years (hazard ratio [HR] = 1.60; 95% confidence interval [CI]: 1.13-2.26), and in those aged 51-60 years (HR = 2.08; 95% CI: 1.27-3.41) and >60 years (HR = 2.98; 95% CI: 1.87-4.73)), but not in men. When comparing fractures in individuals with and without Down syndrome, shoulder and arm fractures were most common in the Down syndrome cohort. CONCLUSION: The results of our study indicate a positive association between individuals with Down syndrome and subsequent fractures in women and those aged >50 years. Prevention of falls appears to be particularly important in these populations. However, future studies should clarify the extent to which socio-economic factors, such as housing, play a role in this context.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13183