Bone mineral density and fractures in institutionalised children with epilepsy and intellectual disability

J.J.L. Berkvens*, S. Mergler, K. Beerhorst, P. Verschuure, I.Y. Tan, H.J.M. Majoie, J.P.W. van den Bergh

*Corresponding author for this work

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Background Long-term use of antiseizure drugs is associated with a low bone mineral density (BMD) and an increased fracture risk. The literature regarding institutionalised children on chronic antiseizure drugs is limited. Therefore, the aim of this cross-sectional study is to evaluate the prevalence of low BMD and the history of fractures in institutionalised children with epilepsy and intellectual disability (ID). Methods A dual-energy X-ray absorptiometry of lumbar spine (L1-L4) and hip was performed in 24 children, residing in a long-stay care facility in the Netherlands. Additionally, serum concentrations of albumin, calcium and 25-hydroxyvitamin D were determined. Data on fractures were retrospectively extracted from the medical files. Results Ages of the children (14 male and 10 female) ranged from 5 to 17 years with a mean age of 13.0 (+/- 3.2). The criteria of the International Society for Clinical Densitometry (ISCD) were used for classification of bone mineral disorders. Eight (33.3%) children had a normal BMD (Z-score > - 2.0). Of the 16 children with a low BMD (Z-score <= - 2.0), three were diagnosed as osteoporotic, based on their fracture history. Ten children (41.7%) were reported to have at least one fracture in their medical history. Serum concentrations of albumin-corrected calcium (2.28-2.50 mmol/L) and (supplemented) vitamin D (16-137 nmol/L) were within the normal range. Conclusions This study demonstrated that 67% of institutionalised children with epilepsy and ID had low BMD and 42% had a history of at least one fracture, despite supplementation of calcium and vitamin D in accordance with the Dutch guidelines.
Original languageEnglish
Pages (from-to)962-970
Number of pages9
JournalJournal of Intellectual Disability Research
Issue number11
Early online date2 Sept 2021
Publication statusPublished - Nov 2021


  • Antiepileptic drugs (AEDs)
  • Bone mineral density (BMD)
  • Children
  • Dual-energy X-ray absorptiometry (DXA)
  • Epilepsy
  • Intellectual Disability (ID)
  • Osteoporosis
  • RISK

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