EFFECTS OF WEIGHT-BEARING ACTIVITIES ON BONE DENSITY IN CHILDREN AND YOUNG ADULTS WITH DOWN SYNDROME: A SYSTEMATIC REVIEW

Abstract

Background: Down syndrome (DS) is the most common chromosomal disorder. Individuals with DS often present with low bone density, which places them at a higher risk of developing osteoporosis and fracture as compared to the general population. Mechanical stress associated with weight-bearing activities (WBA) has been shown to improve bone mineralization in various population. However, the effects of WBA on bone density in children and young adults with DS have not been fully elucidated.Objective: The objective of this review was to investigate whether WBA improved bone mineral density (BMD) and/or bone mineral content (BMC) in children and young adults with DS. Methods: PubMed, Embase and Cinahl were searched through November 15, 2020 for all clinical trials that investigated the effectiveness of WBA in individuals with DS. The search strategy included a list of terms associated with the target population (children and young adults with DS), intervention (WBA), and outcome (BMD and/or BMC). Studies related to whole body vibration were excluded from this review. Risk of bias of the included studies was assessed with PEDro. Results: Four studies with PEDro score ranging from 4-5 were identified through electronic search and a stepwise selection procedure. A total number of 150 individuals with DS were included in this review. The interventional groups received a variety of WBA treatment for 4-12 months, while the control groups did not receive any intervention. Three studies demonstrated that WBA intervention led to a 4.0-14.6% of improvement in BMD and/or BMC at the lumbar spine and femur. The magnitude of improvement was greater than that of the control group (p<0.05). However, WBA intervention did not result in improvement in BMD or BMC as compared to the control group (p>0.05) in one study. Conclusion: Although WBA showed potential in improving bone density in young adults and children with DS, the results from the current systematic review are not conclusive due to inconsistent findings and low level of evidence.