Fracture Characteristics Among Adults With Intellectual Disabilities and Autism Spectrum Disorders to Inform Fracture Prevention Strategies: A Descriptive Study.

This study looked at bone fractures in 126 adults with intellectual disability and/or autism. It found that people with autism alone had more high-energy fractures (50%) compared to those with intellectual disability alone (24%). The most common cause of fractures was falls and accidents during transfers. Leg fractures were most common in people with intellectual disability, while arm fractures were more common in people with autism only.

The findings suggest different prevention strategies may be needed for different groups.

This retrospective cohort study examined fracture characteristics in 126 adults with intellectual disabilities (ID) and/or autism spectrum disorders (ASD) who sustained 147 fractures over nine years. The study found that 32% were high-energy fractures, with variation by subgroup: 24.1% for ID only, 50% for ASD only, and 33.3% for ID+ASD. The most common cause across all groups was 'low-impact falls, unwitnessed falls, transfers' (ranging from 27.8% to 47.1%). Lower extremity fractures were most common in ID only and ID+ASD groups (42.5% and 50% respectively), while upper extremity fractures predominated in the ASD only group (33.3%).

Despite the adult age range, most fractures were low-energy and occurred in extremities, suggesting specific prevention strategies may be beneficial.

Findings suggest need for diagnosis-specific fracture prevention strategies. Adults with ASD may require interventions targeting high-energy fracture prevention, while those with ID may benefit from fall prevention and transfer safety programs. Different anatomical protection strategies may be warranted based on fracture location patterns.

Single-site retrospective study limits generalizability. Sample sizes varied significantly between subgroups (69 ID only vs 35 ASD only vs 22 ID+ASD). Reliance on medical record abstraction may introduce documentation bias and missed fracture events treated elsewhere.

Adults with intellectual disabilities (ID) and autism spectrum disorders (ASD) have a higher risk of fracture; yet little is known about key fracture characteristics that may inform fracture prevention efforts. The objective was to describe the reported activities that lead to a fracture event, the energy of fractures (e.g., low-energy such as fragility fractures and high-energy such as fractures from a motor vehicle accident) and the location of fractures for adults with ID and ASD. In this retrospective cohort study from the United States, medical records from a single clinical site were abstracted to gather information on fracture characteristics (i.e., fracture location, energy of fracture and activities that lead to the fracture event) from adults ≥ 18 years old with intellectual disabilities (ID) and/or autism spectrum disorders (ASD) that sustained ≥ 1 fracture between 1 November 2012 and 2 November 2021. The fracture characteristics were described for the entire cohort and by the following subgroups: ID only, ASD only and ID + ASD.

Of the 126 adults with ID and/or ASD, there were a total of 147 fractures for analysis: 84.9% had one fracture, 13.5% had two fractures and 1.6% had three fractures. For the entire cohort, 32.0% were defined as high-energy fractures, but this varied by subgroup: 24.1% for ID only (n = 69 participants, n = 87 fractures), 50.0% for ASD only (n = 35 participants, n = 36 fractures) and 33.3% for ID + ASD (n = 22 participants, n = 24 fractures). The remaining fractures were defined as low-energy or unknown energy. The most common activities that lead to a fracture event were broadly categorised as 'low-impact falls, unwitnessed falls, transfers' for ID only (47.1%), ASD only (27.8%) and ID + ASD (41.7%).

The most common skeletal region of fractures occurred in the lower extremities for ID only (42.5%) and ID + ASD (50.0%) and in the upper extremities for ASD only (33.3%). Despite the age being 18 years and older (i.e., not exclusively elderly), most fractures were considered to be low-energy and occurred in the extremities, but this varied by subgroup. This study identified the activities that led to a fracture event, which may inform fracture prevention efforts such as adjunct therapies.