Risk of Osteoporosis-Related Fracture in Children and Adolescents with Intellectual Disability

<i>Background and Objectives</i>: Children and adolescents with intellectual disability (ID) experience substantial health disparities, yet their skeletal health has been overlooked. Early-onset osteoporosis and fracture remain underrecognized in this population. Hence, this study assessed the risk of osteoporosis with concomitant fracture in this population using nationwide cohort data. <i>Materials and Methods</i>: This population-based retrospective cohort study examined data from South Korea's National Health Insurance Service-National Health Information Database (2004-2021). In all, 75,790 individuals with ID and 922,921 control individuals aged 2-18 years were included. The primary outcome was osteoporosis with concomitant fracture occurring within 1 year before or after the osteoporosis diagnosis. The secondary outcome was osteoporosis with a pathological fracture. <i>Results</i>: The ID group had a significantly higher risk of developing osteoporosis with concomitant fracture than the control group (unadjusted hazard ratio [HR], 6.821; 95% confidence interval [CI], 5.065-9.187; <i>p</i> < 0.001). This association remained significant after adjusting for demographic factors and medical comorbidities as a composite variable (HR, 4.385; 95% CI, 3.080-6.245; <i>p</i> < 0.001) and after additional adjustment for cerebral palsy (HR, 3.331; 95% CI, 2.252-4.926; <i>p</i> < 0.001). Subgroup analyses showed stronger associations in males (HR, 7.597), younger ages (7-11 years: HR, 9.501), and rural areas (HR, 8.882). <i>Conclusions</i>: Children and adolescents with ID have a high risk of osteoporosis with concomitant fracture. Early assessment and targeted strategies are needed to promote bone health in this population.