Bone mineral density and fractures in institutionalised children with epilepsy and intellectual disability.
Most children with epilepsy and ID in care have weak bones despite supplements—screen early and add weight-bearing activities.
01Research in Context
What this study did
The team visited a home for children with epilepsy and intellectual disability. They scanned each child's bones and asked staff about past broken bones.
Every child already took calcium and vitamin D pills. The study checked if the pills were enough to keep bones strong.
What they found
Two out of three children had low bone density. Four out of ten had already broken at least one bone.
Supplements did not prevent the problem. Bones were still weak even with daily calcium and vitamin D.
How this fits with other research
Costa et al. (2017) saw the same pattern in adults with Down syndrome. Half had thin bones and one-fifth had osteoporosis. Weak bones start early and stay through life.
Klein et al. (2024) tracked fractures for five years. Women with Down syndrome over 50 broke bones twice as often as peers without the disability. The childhood data from Hamama et al. (2021) helps explain why: the risk begins young.
Together the three papers form a timeline. Low bone density appears in childhood, continues into adulthood, and turns into breaks later.
Why it matters
When a new child enters your residential program, ask for a bone scan and fracture history right away. Add weight-bearing exercise to the daily schedule. Request dietitian review even if supplements are already ordered. These quick steps can slow bone loss before it starts.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add five minutes of jumping or stair climbing to the morning group schedule and note tolerance.
02At a glance
03Original abstract
BACKGROUND: Long-term use of antiseizure drugs is associated with a low bone mineral density (BMD) and an increased fracture risk. The literature regarding institutionalised children on chronic antiseizure drugs is limited. Therefore, the aim of this cross-sectional study is to evaluate the prevalence of low BMD and the history of fractures in institutionalised children with epilepsy and intellectual disability (ID). METHODS: A dual-energy X-ray absorptiometry of lumbar spine (L1-L4) and hip was performed in 24 children, residing in a long-stay care facility in the Netherlands. Additionally, serum concentrations of albumin, calcium and 25-hydroxyvitamin D were determined. Data on fractures were retrospectively extracted from the medical files. RESULTS: Ages of the children (14 male and 10 female) ranged from 5 to 17 years with a mean age of 13.0 (±3.2). The criteria of the International Society for Clinical Densitometry (ISCD) were used for classification of bone mineral disorders. Eight (33.3%) children had a normal BMD (Z-score > - 2.0). Of the 16 children with a low BMD (Z-score ≤ - 2.0), three were diagnosed as osteoporotic, based on their fracture history. Ten children (41.7%) were reported to have at least one fracture in their medical history. Serum concentrations of albumin-corrected calcium (2.28-2.50 mmol/L) and (supplemented) vitamin D (16-137 nmol/L) were within the normal range. CONCLUSIONS: This study demonstrated that 67% of institutionalised children with epilepsy and ID had low BMD and 42% had a history of at least one fracture, despite supplementation of calcium and vitamin D in accordance with the Dutch guidelines.
Journal of intellectual disability research : JIDR, 2021 · doi:10.1111/jir.12880