New study shows a substantially higher rate of fractures in people with learning disability

One of the main focuses of the Royal Osteoporosis Society’s new ‘Breaking the Silence Strategy’, launched earlier this year, is Equity. This means that we work hard to ensure that access to osteoporosis treatment and care is equal across the UK.

To help address inequality in osteoporosis treatment and care, a large study was published in September 2022 in eClinicalMedicine, open access journal of The Lancet Discovery Science group, investigating fracture rates in people with learning disabilities (such as Down’s syndrome and other conditions of intellectual impairment), compared to people of the same age and gender without learning disabilities.

The researchers looked at the number of fractures recorded by doctors and hospitals over a 20 year period (1998-2017) and compared the number of fractures experienced by 43,000 individuals with learning disability and 215,000 without, over their lifetime.

The risk of experiencing broken bones increases for everyone as they get older, as bone strength naturally starts to decrease, but the new research found that in those with learning disability the risk of broken bones begins many years earlier than those without a learning disability. It also found that people with learning disabilities were two to ten times more likely to experience a hip fracture than those without, with the largest differences observed in younger adults.

The study revealed that hip fractures were seen to occur around 15 to 25 years earlier in people with learning disability. Ongoing research is investigating the reasons for such high rate of fracture in people with learning disabilities but the research points to early onset osteoporosis as the underlying basis for the increased rates. This could be due to limitations in mobility and sedentary lifestyle, a tendency to fall, and accompanying medical conditions. Recommendations to reduce fracture rates from the study include promotion of safe physical exercise, addressing existing medical disorders and improving living conditions. There could also be opportunities to reduce fracture rates through the wider use of existing drug therapies for osteoporosis. Meanwhile, clinical guidelines should be updated to include people with learning disabilities in those at risk of osteoporotic fracture, particularly hip fracture.

Lead author Valeria Frighi, Senior Clinical Research Fellow at the Department of Psychiatry, said:

‘The study has identified an important and currently unmet health need in the population with learning disabilities. GPs should consider addressing the issue of bone health during the yearly statutory health check offered to people with learning disabilities’

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The research was conducted by the Department of Psychiatry, the Nuffield Department of Primary Care Health Sciences and other departments within the University of Oxford, and Oxford Health NHS Foundation Trust.

The study was led by Dr Valeria Frighi, funded by the National Institute for Health and Care Research, and endorsed by the Royal Osteoporosis Society, the Royal Mencap Society and the Down’s Syndrome Association.