FOXO1 and Hyperglycemia: This is consistent with the systemic hyperglycemia condition that many Down syndrome patients present with [31], which leads us to believe that the PD+IR+ Down syndrome patients in our study have a worse potential for osteogenic differentiation and therefore a lower volume decreased bone formation and trabeculae formation, related to its alteration of FOXO1A gene expression together with its alteration in glucose metabolism.