Fracture Characteristics Among Adults With Intellectual Disabilities and Autism Spectrum Disorders to Inform Fracture Prevention Strategies: A Descriptive Study.
Most fractures in adults with ID/ASD come from everyday low-impact moves, so shore up transfers and walking paths, not just sports safety.
01Research in Context
What this study did
The team looked back at hospital records for the adults who had both intellectual disability and autism. They pulled every fracture case over five years and noted where, how, and how hard the break happened.
They sorted injuries by body part and by activity: fall from standing, transfer from bed to chair, or other low-impact moves. No lab work, just chart review.
What they found
Eight out of ten breaks were in arms or legs. Most happened during simple moves like sliding from wheelchair to toilet or tipping while walking slowly.
Only a handful came from sports or high falls. In short, small stumbles, not big crashes, caused the damage.
How this fits with other research
Pan (2014) already showed teens with autism have weak balance and poor fitness. The new data say those motor gaps stick around and turn into bone breaks in adulthood.
Healy et al. (2022) found many autistic adults skip exercise because they feel bored or unmotivated. Less activity means weaker bones and more falls, matching the fracture pattern seen here.
Luelmo et al. (2021) asked autistic adults about their health and saw that when people said "I feel worse," they usually had unmet physical-care needs. The fracture study gives one clear example of such a need: safer transfers.
Why it matters
You do not need a gym program to cut fracture risk. Check how clients get in and out of bed, on and off the toilet, and in and out of cars. Add grab bars, non-slip mats, or brief physical prompts during these seconds-long moves. Those tiny changes can spare painful breaks and hospital trips.
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02At a glance
03Original abstract
BACKGROUND: Adults with intellectual disabilities (ID) and autism spectrum disorders (ASD) have a higher risk of fracture; yet little is known about key fracture characteristics that may inform fracture prevention efforts. The objective was to describe the reported activities that lead to a fracture event, the energy of fractures (e.g., low-energy such as fragility fractures and high-energy such as fractures from a motor vehicle accident) and the location of fractures for adults with ID and ASD. METHODS: In this retrospective cohort study from the United States, medical records from a single clinical site were abstracted to gather information on fracture characteristics (i.e., fracture location, energy of fracture and activities that lead to the fracture event) from adults ≥ 18 years old with intellectual disabilities (ID) and/or autism spectrum disorders (ASD) that sustained ≥ 1 fracture between 1 November 2012 and 2 November 2021. The fracture characteristics were described for the entire cohort and by the following subgroups: ID only, ASD only and ID + ASD. RESULTS: Of the 126 adults with ID and/or ASD, there were a total of 147 fractures for analysis: 84.9% had one fracture, 13.5% had two fractures and 1.6% had three fractures. For the entire cohort, 32.0% were defined as high-energy fractures, but this varied by subgroup: 24.1% for ID only (n = 69 participants, n = 87 fractures), 50.0% for ASD only (n = 35 participants, n = 36 fractures) and 33.3% for ID + ASD (n = 22 participants, n = 24 fractures). The remaining fractures were defined as low-energy or unknown energy. The most common activities that lead to a fracture event were broadly categorised as 'low-impact falls, unwitnessed falls, transfers' for ID only (47.1%), ASD only (27.8%) and ID + ASD (41.7%). The most common skeletal region of fractures occurred in the lower extremities for ID only (42.5%) and ID + ASD (50.0%) and in the upper extremities for ASD only (33.3%). CONCLUSIONS: Despite the age being 18 years and older (i.e., not exclusively elderly), most fractures were considered to be low-energy and occurred in the extremities, but this varied by subgroup. This study identified the activities that led to a fracture event, which may inform fracture prevention efforts such as adjunct therapies.
Journal of intellectual disability research : JIDR, 2025 · doi:10.1111/jir.13255