Osteoporosis in people with developmental disability

There is an increased prevalence of low bone density, osteopenia, osteoporosis and fragility fractures in adults with developmental disability. Many people with developmental disability, particularly those with Down syndrome, have features of ageing at a younger age than in the general population, which places them at particularly high risk of osteoporosis.

Children and adults with developmental disability may have multiple risk factors for bone mineral density loss, falls and minimal-trauma fracture; general practitioners should assess risk factors annually, starting at an earlier age than in the general population. Consider measuring bone mineral density in those with significant risk factors and where clinically indicated—see Assessing and interpreting bone status.

See here for advice on falls prevention in people with developmental disability.

People with developmental disability who do not have regular sun exposure should have their serum 25-hydroxyvitamin D concentration measured. If deficient, treat as for the general population; see Vitamin D deficiency.

For osteoporosis treatment advice, see Osteoporosis and minimal-trauma fracture. People with developmental disability have increased potential for serious adverse effects from oral bisphosphonates (eg gastrointestinal ulceration, osteonecrosis of the jaw). Ensure a dental check is performed to identify and enable completion of any necessary dental treatment before starting bisphosphonates. During treatment, advise the person (or their carers or family) to immediately report:

• symptoms of epigastric or oral pain
• nausea, vomiting or changes in bowel habit.