Skip to main content
SpringerLink
Log in

Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Patients with autism spectrum disorder (ASD) are at increased risk for fracture, and peri-pubertal boys with ASD have lower bone mineral density (BMD) than controls. Data are lacking regarding BMD in older adolescents with ASD. We compared BMD using dual-energy X-ray absorptiometry in 9 adolescents/young adults with ASD against 9 typically developing matched controls. Patients with ASD and controls were excluded if they had other underlying conditions that may affect bone. Compared to controls, patients with ASD had (i) lower femoral neck and hip BMD Z-scores, and (ii) lower spine, femoral neck and hip height adjusted BMD Z-scores even after controlling for BMI. Understanding the underlying pathophysiology will be key to developing therapies to improve BMD and reduce fracture risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual disorders (5th ed.). VA: American Psychiatric Association.

    Book  Google Scholar 

  • Babayigit, A., Dirik, E., Bober, E., & Cakmakci, H. (2006). Adverse effects of antiepileptic drugs on bone mineral density. Pediatric Neurology, 35(3), 177–181. doi:10.1016/j.pediatrneurol.2006.03.004.

    Article  PubMed  Google Scholar 

  • Beniczky, S. A., Viken, J., Jensen, L. T., & Andersen, N. B. (2012). Bone mineral density in adult patients treated with various antiepileptic drugs. Seizure, 21(6), 471–472. doi:10.1016/j.seizure.2012.04.002.

    Article  PubMed  Google Scholar 

  • Calarge, C. A., Burns, T. L., Schlechte, J. A., & Zemel, B. S. (2015). Longitudinal examination of the skeletal effects of selective serotonin reuptake inhibitors and risperidone in boys. Journal of Clinical Psychiatry, 76(5), 607–613. doi:10.4088/JCP.14m09195.

    Article  PubMed  Google Scholar 

  • Chou, I. J., Lin, K. L., Wang, H. S., & Wang, C. J. (2007). Evaluation of bone mineral density in children receiving carbamazepine or valproate monotherapy. Acta Paediatrica Taiwanica, 48(6), 317–322.

    PubMed  Google Scholar 

  • Davies, J. H., Evans, B. A., & Gregory, J. W. (2005). Bone mass acquisition in healthy children. Archives of Disease in Childhood, 90(4), 373–378. doi:10.1136/adc.2004.053553.

    Article  PubMed  PubMed Central  Google Scholar 

  • Deere, K., Sayers, A., Rittweger, J., & Tobias, J. H. (2012). A cross-sectional study of the relationship between cortical bone and high-impact activity in young adult males and females. Journal of Clinical Endocrinology and Metabolism, 97(10), 3734–3743. doi:10.1210/jc.2012-1752.

    Article  PubMed  PubMed Central  Google Scholar 

  • Emin, O., Fatih, M., Emre, D., & Nedim, S. (2011). Lack of bone metabolism side effects after 3 years of nasal topical steroids in children with allergic rhinitis. Journal of Bone and Mineral Metabolism, 29(5), 582–587. doi:10.1007/s00774-010-0255-3.

    Article  PubMed  Google Scholar 

  • Estrada, K., Styrkarsdottir, U., Evangelou, E., Hsu, Y. H., Duncan, E. L., Ntzani, E. E., et al. (2012). Genome-wide meta-analysis identifies 56 bone mineral density loci and reveals 14 loci associated with risk of fracture. Nature Genetics, 44(5), 491–501. doi:10.1038/ng.2249.

    Article  PubMed  PubMed Central  Google Scholar 

  • Freedberg, D. E., Haynes, K., Denburg, M. R., Zemel, B. S., Leonard, M. B., Abrams, J. A., et al. (2015). Use of proton pump inhibitors is associated with fractures in young adults: A population-based study. Osteoporosis International, 26(10), 2501–2507. doi:10.1007/s00198-015-3168-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ginty, F., Rennie, K. L., Mills, L., Stear, S., Jones, S., & Prentice, A. (2005). Positive, site-specific associations between bone mineral status, fitness, and time spent at high-impact activities in 16- to 18-year-old boys. Bone, 36(1), 101–110. doi:10.1016/j.bone.2004.10.001.

    Article  PubMed  Google Scholar 

  • Hediger, M. L., England, L. J., Molloy, C. A., Yu, K. F., Manning-Courtney, P., & Mills, J. L. (2008). Reduced bone cortical thickness in boys with autism or autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(5), 848–856. doi:10.1007/s10803-007-0453-6.

    Article  PubMed  Google Scholar 

  • Hyman, S. L., Stewart, P. A., Schmidt, B., Cain, U., Lemcke, N., Foley, J. T., et al. (2012). Nutrient intake from food in children with autism. Pediatrics, 130(Suppl 2), S145–S153. doi:10.1542/peds.2012-0900L.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanis, J. A., Johnell, O., De Laet, C., Johansson, H., Oden, A., Delmas, P., et al. (2004). A meta-analysis of previous fracture and subsequent fracture risk. Bone, 35(2), 375–382. doi:10.1016/j.bone.2004.03.024.

    Article  PubMed  Google Scholar 

  • Lehtonen-Veromaa, M. K., Mottonen, T. T., Nuotio, I. O., Irjala, K. M., Leino, A. E., & Viikari, J. S. (2002). Vitamin D and attainment of peak bone mass among peripubertal Finnish girls: A 3-y prospective study. American Journal of Clinical Nutrition, 76(6), 1446–1453.

    PubMed  Google Scholar 

  • Neumeyer, A. M., Gates, A., Ferrone, C., Lee, H., & Misra, M. (2013). Bone density in peripubertal boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(7), 1623–1629. doi:10.1007/s10803-012-1709-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Neumeyer, A. M., O’Rourke, J. A., Massa, A., Lee, H., Lawson, E. A., McDougle, C. J., et al. (2015). Brief report: Bone fractures in children and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(3), 881–887. doi:10.1007/s10803-014-2228-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nishiyama, K. K., Macdonald, H. M., Moore, S. A., Fung, T., Boyd, S. K., & McKay, H. A. (2012). Cortical porosity is higher in boys compared with girls at the distal radius and distal tibia during pubertal growth: An HR-pQCT study. Journal of Bone and Mineral Research, 27(2), 273–282. doi:10.1002/jbmr.552.

    Article  PubMed  Google Scholar 

  • Pan, C. Y. (2008). Objectively measured physical activity between children with autism spectrum disorders and children without disabilities during inclusive recess settings in Taiwan. Journal of Autism and Developmental Disorders, 38(7), 1292–1301. doi:10.1007/s10803-007-0518-6.

    Article  PubMed  Google Scholar 

  • Rieger-Wettengl, G., Tutlewski, B., Stabrey, A., Rauch, F., Herkenrath, P., Schauseil-Zipf, U., et al. (2001). Analysis of the musculoskeletal system in children and adolescents receiving anticonvulsant monotherapy with valproic acid or carbamazepine. Pediatrics, 108(6), E107.

    Article  PubMed  Google Scholar 

  • Riggs, B. L., & Melton, L. J, 3rd. (1986). Involutional osteoporosis. New England Journal of Medicine, 314(26), 1676–1686. doi:10.1056/NEJM198606263142605.

    Article  PubMed  Google Scholar 

  • Roke, Y., van Harten, P. N., Buitelaar, J. K., Tenback, D. E., Quekel, L. G., de Rijke, Y. B., et al. (2012). Bone mineral density in male adolescents with autism spectrum disorders and disruptive behavior disorder with or without antipsychotic treatment. European Journal of Endocrinology, 167(6), 855–863. doi:10.1530/EJE-12-0521.

    Article  PubMed  Google Scholar 

  • Schoenau, E. (2005). From mechanostat theory to development of the “functional muscle-bone-unit”. Journal of Musculoskeletal and Neuronal Interactions, 5(3), 232–238.

    PubMed  Google Scholar 

  • Serin, H. M., Koc, Z. P., Temelli, B., & Esen, I. (2015). The bone mineral content alterations in pediatric patients medicated with levetiracetam, valproic acid, and carbamazepine. Epilepsy & Behavior, 51, 221–224. doi:10.1016/j.yebeh.2015.06.025.

    Article  Google Scholar 

  • Sheth, R. D., Binkley, N., & Hermann, B. P. (2008). Progressive bone deficit in epilepsy. Neurology, 70(3), 170–176. doi:10.1212/01.wnl.0000284595.45880.93.

    Article  PubMed  Google Scholar 

  • Tan, V. P., Macdonald, H. M., Kim, S., Nettlefold, L., Gabel, L., Ashe, M. C., et al. (2014). Influence of physical activity on bone strength in children and adolescents: A systematic review and narrative synthesis. Journal of Bone and Mineral Research, 29(10), 2161–2181. doi:10.1002/jbmr.2254.

    Article  PubMed  Google Scholar 

  • Tekgul, H., Serdaroglu, G., Huseyinov, A., & Gokben, S. (2006). Bone mineral status in pediatric outpatients on antiepileptic drug monotherapy. Journal of Child Neurology, 21(5), 411–414.

    PubMed  Google Scholar 

  • Theintz, G., Buchs, B., Rizzoli, R., Slosman, D., Clavien, H., Sizonenko, P. C., et al. (1992). Longitudinal monitoring of bone mass accumulation in healthy adolescents: Evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. Journal of Clinical Endocrinology and Metabolism, 75(4), 1060–1065. doi:10.1210/jcem.75.4.1400871.

    PubMed  Google Scholar 

  • Warden, S. J., Burr, D. B., & Brukner, P. D. (2006). Stress fractures: Pathophysiology, epidemiology, and risk factors. Curr Osteoporos Rep, 4(3), 103–109.

    Article  PubMed  Google Scholar 

  • Wren, T. A., Kalkwarf, H. J., Zemel, B. S., Lappe, J. M., Oberfield, S., & Shepherd, J. A. (2014). Longitudinal tracking of dual-energy X-ray absorptiometry bone measures over 6 years in children and adolescents: Persistence of low bone mass to maturity. The Journal of Pediatrics, 164(6), 1280–1285. doi:10.1016/j.jpeds.2013.12.040.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yaghini, O., Tonekaboni, S. H., Amir Shahkarami, S. M., Ahmad Abadi, F., Shariat, F., & Abdollah Gorji, F. (2015). Bone mineral density in ambulatory children with epilepsy. Indian Journal of Pediatrics, 82(3), 225–229. doi:10.1007/s12098-014-1518-0.

    Article  PubMed  Google Scholar 

Download references

Author Contributions

MM and AMN conceived the study and interpreted the data. LE, CB, KJC and NCS collected the data and interpreted the data. LE and KJC performed the statistical analysis. LE and CB drafted the manuscript. All authors read and approved the final manuscript.

Author information

Author notes

    Authors and Affiliations

    1. Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, 55 Fruit Street, Yawkey 6c, Boston, MA, 02114, USA

      Laya Ekhlaspour, Charumathi Baskaran & Madhusmita Misra

    2. Neuroendocrine Unit, Massachusetts General Hospital, 101 Merrimac St, 6th Floor, Office 615, Boston, MA, 02114, USA

      Karen Joanie Campoverde & Natalia Cano Sokoloff

    3. Lurie Center for Autism, Massachusetts General Hospital and Harvard Medical School, One Maguire Road, Lexington, MA, 02421, USA

      Ann M. Neumeyer

    Authors
    1. Laya Ekhlaspour
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Charumathi Baskaran
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Karen Joanie Campoverde
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Natalia Cano Sokoloff
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Ann M. Neumeyer
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Madhusmita Misra
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Laya Ekhlaspour.

    Additional information

    Laya Ekhlaspour, Charumathi Baskaran have contributed equally to this work.

    Electronic Supplementary Material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (DOCX 11 kb)

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Ekhlaspour, L., Baskaran, C., Campoverde, K.J. et al. Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders. J Autism Dev Disord 46, 3387–3391 (2016). https://doi.org/10.1007/s10803-016-2871-9

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10803-016-2871-9

    Keywords

    Search

    Navigation