Global variation of low bone mineral density in special olympics adult athletes with intellectual and developmental disability—A cross-sectional study

Adults with intellectual and developmental disabilities (IDD) face a high risk of low bone mineral density (LBMD), a key osteoporosis indicator, yet global data remains limited. Understanding LBMD prevalence among adults with IDD is crucial for targeted public health interventions. This study examines LBMD variations in Special Olympics athletes, stratified by age, sex, and World Health Organization (WHO) global region, and explores bone mineral density (BMD) levels achieved during peak bone mass (PBM) age (20-29 years). This cross-sectional study analyzed data from 25,868 Special Olympics athletes (20 + years) screened in Healthy Athletes between 2011-2023. BMD testing was conducted by licensed clinicians, and institutional review board approval was obtained to use this deidentified data. BMD was assessed via Quantitative Ultrasound, and WHO criteria classified T-score status. LBMD prevalence (<-1.0 T-score) was examined across age, sex, and global regions. Chi-square, rate ratios with 95% confidence intervals, and binomial logistic regression were calculated to analyze LBMD and PBM across age, WHO regions, and sex. Overall, 26.9% had LBMD, with similar prevalence in males (27.3%) and females (26.3%). LBMD increased annually by 1.43% in males and 2.50% in females. Highest LBMD prevalence was seen in Eastern Mediterranean females (52.4%) and Southeast Asian males (48.7%) and females (45.5%). Alarmingly, 54.9% failed to achieve optimal BMD (≥0.0) before age 30, with 24.4% of 20-29-year-olds already having LBMD. These findings highlight the need for early interventions, including nutrition, weight-bearing exercise, and routine screening, to improve bone health and reduce healthcare costs in adults with IDD. Policymakers must prioritize bone health initiatives to address disparities and enhance lifelong skeletal health.