Osteoporosis International

, Volume 24, Issue 4, pp 1333–1338 | Cite as

Low bone turnover and low bone density in a cohort of adults with Down syndrome

  • K. D. McKelvey
  • T. W. Fowler
  • N. S. Akel
  • J. A. Kelsay
  • D. Gaddy
  • G. R. Wenger
  • L. J. Suva
Original Article

Abstract

Summary

Increased incidence of osteoporosis in Down syndrome has been reported, but etiology is not established. We report low bone turnover markers and bone mineral density (BMD) in a cohort of people with Down syndrome without consistent clinical risk factors. Our results should guide future studies and treatments for this common problem.

Introduction

To better understand the etiology for osteoporosis in Down syndrome (DS), we measured bone density by dual-energy X-ray absorptiometry (DXA) and circulating biochemical markers of bone formation and resorption in a cohort of 30 community-dwelling DS adults.

Methods

Seventeen males and 13 females followed in the University of Arkansas Down Syndrome Clinic were evaluated by DXA to estimate BMD and underwent phlebotomy to measure serum procollagen type-1 intact N-terminal propeptide (P1NP) to evaluate bone formation, and serum C-terminal peptide of type-I collagen (CTx) to evaluate bone resorption.

Results

Seven of 13 DS females and 12 of 17 DS males had low bone mass at one of measured sites (z ≤ −2.0). When data were grouped by age, males had apparent osteopenia earlier than females. The mean P1NP in the normal group was 19.2 ± 5.2 ng/ml vs. 2.2 ± 0.9 ng/ml in the DS group (P = 0.002). Serum CTx levels in the normal group were 0.4 ± 0.1 ng/ml vs. 0.3 ± 0.1 ng/ml (P = 0.369).

Conclusions

Low BMD in adults with DS is correlated with a significant decrease in bone formation markers, compared to controls without DS, and is independent of gender. These data suggest that diminished osteoblastic bone formation and inadequate accrual of bone mass, with no significant differences in bone resorption, are responsible for the low bone mass in DS. These observations question the use of antiresorptive therapy in this population and focus attention on increasing bone mass by other interventions.

Keywords

Bone density Bone turnover Down syndrome Osteopenia Osteoporosis Trisomy 21 

Notes

Acknowledgments

This work was supported by the Rockefeller Chair in Clinical Genetics (KDM), the UAMS Translational Research Institute (TRI) clinical award (KDM), UAMS TRI UL1RR029884, and the Carl L. Nelson Endowed Chair in Orthopaedic Creativity (LJS).

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • K. D. McKelvey
    • 1
    • 2
  • T. W. Fowler
    • 3
    • 4
  • N. S. Akel
    • 3
  • J. A. Kelsay
    • 2
  • D. Gaddy
    • 3
    • 4
  • G. R. Wenger
    • 5
  • L. J. Suva
    • 3
    • 4
  1. 1.Department of Family MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Department of Medical GeneticsUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Department of Physiology and BiophysicsUniversity of Arkansas for Medical SciencesLittle RockUSA
  4. 4.Department of Orthopaedic Surgery, Center for Orthopaedic ResearchUniversity of Arkansas for Medical SciencesLittle RockUSA
  5. 5.Department of Pharmacology and ToxicologyUniversity of Arkansas for Medical SciencesLittle RockUSA

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