University of Saskatchewan College of Kinesiology, Saskatoon, Canada.
Lurie Center for Autism, Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA.
Osteoporos Int. 2021 Sep;32(9):1679-1691. doi: 10.1007/s00198-021-05931-5. Epub 2021 Apr 29.
Higher risk of fracture reported in individuals with autism spectrum disorder (ASD) might be linked to poor bone health and development in childhood. This study aimed to systematically review studies comparing imaged bone outcomes between children with ASD and typically developing children (TDC) or reference data, and to perform a meta-analysis comparing commonly reported bone outcomes. We searched articles published since August 2020 from PubMed, Cochrane Library, Web of Science, EMBASE, and Scopus databases. We included studies comparing areal bone mineral density (aBMD) between children with ASD and TDC in the qualitative analysis (meta-analysis), and evaluated other imaged bone outcomes qualitatively. Seven publications were identified for the systematic review, and four studies were included in the meta-analysis. The meta-analysis indicated lower aBMD at the total body (standardized mean difference = - 0.77; 95% CI, - 1.26 to - 0.28), lumbar spine (- 0.69; - 1.00 to - 0.39), total hip (- 1.00; - 1.82 to - 0.17), and femoral neck (- 1.07; - 1.54 to - 0.60) in children with ASD compared to TDC. Based on our qualitative review, limited evidence suggested 13% lower bone mineral content at the total body and 10-20% lower cortical area, cortical and trabecular thickness, and bone strength at the distal radius and tibia in children with ASD. Children with ASD have lower aBMD at the total body, lumbar spine, and hip and femoral neck compared to TDC. Limited evidence also suggests deficits in bone mineral content, micro-architecture, and strength in children with ASD.
患有自闭症谱系障碍 (ASD) 的个体报告骨折风险较高，这可能与儿童期骨骼健康和发育不良有关。本研究旨在系统地综述比较 ASD 儿童与典型发育儿童（TDC）或参考数据的影像学骨结局的研究，并进行比较常见报告的骨结局的荟萃分析。我们从 PubMed、Cochrane 图书馆、Web of Science、EMBASE 和 Scopus 数据库中检索了自 2020 年 8 月以来发表的文章。我们将比较 ASD 儿童和 TDC 儿童之间的面积骨矿物质密度（aBMD）的研究纳入定性分析（荟萃分析），并定性评估其他影像学骨结局。系统综述确定了 7 篇出版物，4 项研究纳入荟萃分析。荟萃分析表明 ASD 儿童的全身（标准化均数差=-0.77；95%CI，-1.26 至-0.28）、腰椎（-0.69；-1.00 至-0.39）、全髋（-1.00；-1.82 至-0.17）和股骨颈（-1.07；-1.54 至-0.60）的 aBMD 低于 TDC。基于我们的定性综述，有限的证据表明 ASD 儿童的全身骨矿物质含量低 13%，桡骨远端和胫骨的皮质面积、皮质和小梁厚度以及骨强度低 10-20%。与 TDC 相比，ASD 儿童的全身、腰椎和髋部以及股骨颈的 aBMD 较低。有限的证据还表明 ASD 儿童的骨矿物质含量、微观结构和强度存在缺陷。
