Research Summary

Intellectual Disability and Osteoporosis – Why is it so common and what can we do about it?

Dr. Fakhri Shafai, Chief Science Officer, AIDE Canada
Osteoporosis can lead to serious bone fractures and breaks if a person falls. In this research summary, we summarize what we know about osteoporosis and why it tends to be more common in individuals with intellectual disabilities. We also provide suggestions on how best to prevent and/or treat osteoporosis to improve overall health and prevent broken bones later in life.

Photo Credit: Marcus Aurelius on Pexels


What is Osteoporosis?

Osteoporosis is a bone disease that weakens your bones and makes it more likely that a person will have broken bones and fractures if they fall or are injured. Our bones are constantly breaking down and being replaced with new bone to be strong. For people with osteoporosis, bone is being broken down faster than it is being replaced. This leads to bones that are weaker and less dense (less solid) than they normally are.

Osteoporosis is a gradual process that begins with osteopenia, meaning that the bones become weaker, but are not so bad that they will break easily. It is more common in women and

impacts roughly 20% of all those over the age of 50. This is because women have less bone mass to begin with and also lose it faster, especially after menopause. Five percent of males will also develop osteoporosis after the age of 50, especially if they have certain risk factors (see below).


What are some of the common risk factors for osteoporosis?

In addition to gender and age being associated with osteoporosis, people who have long term use of certain medications, smoke cigarettes, or use alcohol regularly are at the highest risk. Those who go through premature menopause (especially if the ovaries were removed) or have rheumatoid arthritis are also more likely to develop osteoporosis. People who are underweight also are at risk.


What does the research say about why osteoporosis is so common in people with intellectual disabilities?

Recent research has suggested that there are a few possible reasons that people with intellectual disabilities are more likely to have osteoporosis than their neurotypical peers:

  • Medications: As mentioned above, certain medications, especially corticosteroids and antiepileptic medications, can increase the risk of osteoporosis. Twenty-two percent of people with an intellectual disability also have epilepsy, which requires the long-term use of medication to manage. If you have been on these types of medications for an extended period, please discuss your risks for osteoporosis with your doctor.
  • Diet: People with intellectual disabilities are less likely to have enough vitamin D and calcium in their diet and are less likely to take supplements to support their bone health. Making dietary changes (described below) can help.
  • Exercise: Certain physical activities help to support bone health as we age. People with intellectual disabilities are less likely to participate in regular exercise and tend to spend more of their day sitting than do their neurotypical peers.
  • Premature aging: People with intellectual disabilities tend to have aging-related health issues before their neurotypical peers. Some possible reasons for this may include having certain genes, entering menopause earlier, or having higher amounts of inflammation at an earlier age.
  • Alcohol and drug use: People with intellectual disabilities are also more likely to smoke cigarettes, drink alcohol, or use other drugs. This prolonged drug and/or alcohol use can make bones weaker as we age.


How can my doctor diagnose osteoporosis?

Bone density scans measure how strong bones are by looking at how solid (i.e., thick, dense) the bones are. There are a few different ways to do a bone density scan, and your doctor or region may only offer one or two options. The gold standard test is called a DEXA scan, which is a type of X-ray. Blood tests may also be done to test for the breakdown of proteins needed for bone health. It is often recommended to get this type of scan for women over the age of 65 and men over the age of 70.


What can I do with this information?

Preventing osteoporosis is the best way to avoid having serious bone fractures in your older years. Even those who have already developed it can help slow bone loss by doing the following:

  • Regular physical activity: Weight-bearing aerobic exercises like walking, jogging, and weight-lifting all help your bones build density. Physical activities like tennis, dancing, and hiking are also helpful for bone health. Also, exercises that help maintain balance (e.g., yoga, Tai Chi, etc.) and posture can prevent falls as you age. Osteoporosis Canada has a series of exercises they call ‘Too Fit to Fall or Fracture’ with specific exercises to try as you build strength and balance.
  • Healthy Diet: Foods rich in calcium, vitamin D, and protein are important for bone health. Eating leafy green vegetables, fish, whole grains, and low-fat dairy regularly will help to strengthen bones as you age. Milk and juices that are fortified with calcium and vitamin D can also help. For specific recipes that can help, check out Osteoporosis Canada’s Nutrition section.
  • See your doctor: If you are at risk for premature aging or have prolonged use of certain medications, ask your doctor about getting a bone density scan at an earlier age. If you do end up having weaker bones, there are some medications they can prescribe to help both slow the loss and increase bone production.



Osteoporosis is something we should all try to prevent as we age. Taking part in physical activity and eating well can go a long way to help maintain strong bones. It is worth taking care of yourself now to avoid fractures and broken bones when you are older.


Additional Resources:

Osteoporosis Canada

Preventing Falls and Fractures - National Institute of Health

Exercising with Osteoporosis - Mayo Clinic

Nutrition for Bones – Royal Osteoporosis Society



Frighi, V., Morovat, A., Andrews, T. M., Rana, F., Stephenson, M. T., White, S. J., ... & Goodwin, G. M. (2019). Vitamin D, bone mineral density and risk of fracture in people with intellectual disabilities. Journal of Intellectual Disability Research63(4), 357-367.

Winterhalder, R., & Shankar, R. (2022). Bone health in adults with epilepsy and intellectual disability. British Journal of General Practice72(716), 100-101.

Fritz, R., Edwards, L., & Jacob, R. (2021). Osteoporosis in adult patients with intellectual and developmental disabilities: special considerations for diagnosis, prevention, and management. Southern Medical Journal114(4), 246-251.

Frighi, V., Smith, M., Andrews, T. M., Clifton, L., Collins, G. S., Fuller, A., ... & Holt, T. A. (2022). Incidence of fractures in people with intellectual disabilities over the life course: a retrospective matched cohort study. EClinicalMedicine52.

Burke, É. A., Carroll, R., Ding, A. W., Yaman, M., Walsh, J. B., McCallion, P., & McCarron, M. (2021). Men's Bones Matter Too, a Cross Sectional Study Examining Bone Health among Men with Intellectual Disability in Ireland. OBM Geriatrics5(4), 1-22.

Liao, P., Vajdic, C., Trollor, J., & Reppermund, S. (2021). Prevalence and incidence of physical health conditions in people with intellectual disability–a systematic review. PloS one16(8), e0256294.

National Institute on Aging. (2022). Osteoporosis. National Institute of Health.

Public Health Agency of Canada. (2022). Osteoporosis. Government of Canada

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