Context
Prader-Willi syndrome (PWS) is a rare complex genetic syndrome, characterized by delayed psychomotor development, hypotonia and hyperphagia. Hormone deficiencies like hypogonadism, hypothyroidism and growth hormone deficiency are common. The combination of hypotonia, low physical activity and hypogonadism might lead to a decrease in bone mass and increase in fracture risk. Moreover, one would expect an increased risk of scoliosis due to hypotonia and low physical activity.
Objective
To study the prevalence and risk factors for skeletal problems (reduced bone mineral density, fractures, and scoliosis) in adults with PWS.
Methods
We retrospectively collected patient characteristics, medical history, medication, biochemical measurements, Dual-energy X-ray Absorptiometry (DEXA) scans, and spinal X-rays and reviewed the current literature.
Results
We included 354 adults with PWS (median age 31 years; 43% males), of whom 51 (14%) had osteoporosis (T -score below -2.5) and 143 (54%) had osteopenia (T-score -1 to -2.5). The most prevalent modifiable risk factors for osteoporosis were hypogonadism, insufficient dairy intake, sedentary lifestyle, and corticosteroid use. Male sex was associated with osteoporosis (p= 0.005). Growth hormone treatment was not associated with osteoporosis. A history of vertebral fractures was present in 10 (3%) and non-vertebral fractures in 59 (17%). Scoliosis was present in 263 (80%), but no modifiable risk factors were identified.
Conclusion
Besides scoliosis, osteoporosis is common in adults with PWS. Based on the literature and the risk factors for osteoporosis found in our cohort, we provide practical clinical recommendations to avoid skeletal complications in these vulnerable patients.
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