Age and sex‐specific risk in fractures with Down syndrome in a retrospective case–control study from Germany

• Published in: Journal of intellectual disability research 2024-12, Vol.68 (12), p.1374-1385
• Main Authors: Krieg, S., Krieg, A., Kostev, K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Age groups; Aged; Case-Control Studies; Cohort analysis; Comorbidity; Down syndrome; Down Syndrome - epidemiology; Economic factors; Female; Fractures; Fractures, Bone - epidemiology; Germany - epidemiology; health inequities; Housing; Humans; Incidence; intellectual disability; Life expectancy; Male; Medical diagnosis; Middle Aged; Propensity; Regression (Statistics); Retrospective Studies; Sex Factors; trauma; Women; Young Adult
• ISSN: 0964-2633; 1365-2788; 1365-2788
• DOI: 10.1111/jir.13183

Background The increasing life expectancy of individuals with Down syndrome has led to a growing awareness of mid‐ and late‐life conditions. Methods Based on the Disease Analyser database (IQVIA), this retrospective cohort study compared adults ≥18 years of age with Down syndrome (ICD‐10: Q90) in general practices in Germany with a propensity score‐matched cohort without Down syndrome. The outcome was the first diagnosis of a fracture within 5 years of the index date. The cumulative incidence of fractures over a 5‐year period was presented using Kaplan–Meier curves. Univariable Cox regression analyses by age group and sex were performed to assess the association between Down syndrome and fractures. Results A total of 2547 individuals with Down syndrome and 12 735 individuals without Down syndrome were included in the study. A significantly higher cumulative fracture incidence within 5 years was observed in the age group 51–60 years (9.3% Down syndrome vs. 4.8% without Down syndrome, P = 0.003) as well as in the age group >60 years (20.3% Down syndrome vs. 8.6% without Down syndrome, P 60 years (HR = 2.98; 95% CI: 1.87–4.73)), but not in men. When comparing fractures in individuals with and without Down syndrome, shoulder and arm fractures were most common in the Down syndrome cohort. Conclusion The results of our study indicate a positive association between individuals with Down syndrome and subsequent fractures in women and those aged >50 years. Prevention of falls appears to be particularly important in these populations. However, future studies should clarify the extent to which socio‐economic factors, such as housing, play a role in this context.