Elevated fracture risk for adults with neurodevelopmental disabilities

Whitney, Daniel G.<sup>1,2</sup>; Caird, Michelle S.<sup>3</sup>; Jepsen, Karl J.<sup>3</sup>; Kamdar, Neil S.<sup>2,4,5,6</sup>; Marsack-Topolewski, Christina N.<sup>7</sup>; Hurvitz, Edward A.<sup>1</sup>; Peterson, Mark D.<sup>1,2</sup>

Affiliations

¹Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower, Ann Arbor, MI 48108, USA

²Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA

³Department of Orthopaedic Surgery, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, USA

⁴Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

⁵Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

⁶Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

⁷School of Social Work, Eastern Michigan University, 317 Everett L. Marshall Building, Ypsilanti, MI 48197, USA

Abstract and keywords

Background: Fracture is a high-burden condition that accelerates unhealthful aging and represents a considerable economic burden. Adults with neurodevelopmental disabilities (NDDs) may be susceptible for fracture at younger ages compared to adults without NDDs; and yet, very little is known about the burden of fracture for these underserved populations. The purpose of this study was to determine the sex-stratified prevalence of all-cause fracture among adults with NDDs, as compared to adults without NDDs, and if comorbidity of NDDs is associated with greater risk of fracture.

Methods: Data from 2016 were extracted from Optum Clinformatics® Data Mart (private insurance) and a random 20% sample from Medicare fee-for-service (public insurance). ICD-10-CM diagnosis codes were used to identify adults with NDDs, including intellectual disabilities, autism spectrum disorders, and cerebral palsy. Age-standardized prevalence of any fracture and fracture by anatomical location was compared between adults with and without NDDs, and then for adults with 1 NDD vs. 2 and 3 NDDs.

Results: Adults with intellectual disabilities (n = 69,456), autism spectrum disorders (n = 21,844), and cerebral palsy (n = 29,255) had a higher prevalence of any fracture compared to adults without NDDs (n = 8.7 million). For women, it was 8.3%, 8.1%, and 8.5% vs. 3.5%, respectively. For men, it was 6.6%, 5.9%, and 6.7% vs. 3.0%, respectively. Women with NDDs had a higher prevalence of fracture of the head/neck, thoracic, lumbar/pelvis, upper extremities, and lower extremities compared to women without NDDs. A similar pattern was observed for men, except for no difference for lumbar/pelvis for all NDDs and thoracic for autism spectrum disorders. For women and men, increasing comorbidity of NDDs was associated with a higher prevalence of any fracture: 1 NDD (women, 7.7%; men, 5.7%); 2 NDDs (women, 9.4%; men, 7.2%); all 3 NDDs (women, 11.3%; men, 13.7%).

Conclusions: Study findings suggest that adults with NDDs have an elevated prevalence of fracture compared to adults without NDDs, with the fracture risk being higher with greater numbers of comorbid NDD conditions for most anatomical locations. Our study findings indicate a need for earlier screening and preventive services for musculoskeletal frailty for adults with NDDs.

Keywords: Fracture; Epidemiology; Intellectual disabilities; Autism spectrum disorders; Cerebral palsy; Neurodevelopmental disabilities

Links

DOI: 10.1016/j.bone.2019.115080

PubMed: 31655219

WoS: 000503321100016

History

Received: 2019-07-13

Revised: 2019-09-13

Accepted: 2019-09-25

Online: 2019-10-24

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Cited By (4)

Year	Entry
2021	Helderman RC, Whitney DG, Duta-Mare M, Akhmetshina A, Vujic N, Jayapalan S, Nyman JS, Misra BB, Rosen CJ, Czech MP, Kratky D, Rendina-Ruedy E. Loss of function of lysosomal acid lipase (LAL) profoundly impacts osteoblastogenesis and increases fracture risk in humans. Bone. July 2021;148:115946.
2021	Whitney DG, Hurvitz EA, Caird MS. Critical periods of bone health across the lifespan for individuals with cerebral palsy: informing clinical guidelines for fracture prevention and monitoring. Bone. September 2021;150:116009.
2023	Whitney DG, Xu T, Whibley D, Erickson SR. High cardiorespiratory disease burden following a fracture among adults with intellectual disabilities. Bone. July 2023;172:116784.
2023	Whitney DG, Caird MS, Raggio CL, Hurvitz EA, Clines GA, Jepsen KJ. Perspective: a multi-trait integrative approach to understanding the structural basis of bone fragility for pediatric conditions associated with abnormal bone development. Bone. October 2023;175:116855.