Osteoporosis in Adult Patients With Intellectual and Developmental Disabilities

Special Considerations for Diagnosis, Prevention, and Management

Rachel Fritz, BS; Linda Edwards, MD; Rafik Jacob, MD


South Med J. 2021;114(4):246-251. 

In This Article

Abstract and Introduction


As medical care progresses, patients with intellectual and developmental disabilities are living longer and beginning to experience diseases that commonly afflict the aging population, such as osteoporosis. Osteoporosis and resultant fractures increase disability and threaten the independence of this vulnerable population. In addition, the diagnosis, prevention, and management of osteoporosis present unique challenges in these patients. Critical preventive targets include exercise modification, fall prevention, and monitoring for nutrient deficiencies. Commonly used in diagnosis and treatment monitoring, dual-energy x-ray absorptiometry (DXA) scan of the hip and spine may not be feasible, whereas peripheral DXA or computed tomography may be more accessible for patients with physical disabilities. Pharmacological treatment should be tailored to the individual patient, considering factors such as adherence and comorbidities. Finally, bone turnover markers are a noninvasive, cost-effective option for monitoring treatment response in patients who cannot undergo DXA.


Intellectual and developmental disabilities (IDDs) encompass a broad group of disorders that may negatively affect a person's cognitive, social, emotional, and/or physical development.[1] Initially evident at birth or during childhood, these disorders are typically incurable.[2] As a result of advances in medical care, the life expectancy of most individuals with IDDs approaches that of people without IDDs, and consideration must be taken to prevent and treat diseases commonly afflicting older adults such as diabetes mellitus, cardiovascular disease, dementia, and osteoporosis (OP).[2,3]

OP is a disease of particular importance, because it may present earlier and with greater severity in patients with IDD.[4] Defined as low mass and structural deterioration of bone, OP leads to skeletal fragility and an increased risk of fracture.[5] OP is especially hazardous in patients with IDD, as fractures increase morbidity and mortality and exacerbate existing disability.[6] Clinical trials to determine safe and effective treatments for OP in this unique population are lacking, and there is a need for educational literature on this topic. This article reviews the etiology of OP in adults with various forms of IDD. It also examines current clinical approaches to diagnosis, prevention, and treatment of OP in adults with IDD.