Translocation
Translocation is the movement of a piece or a whole chromosome onto another chromosome. The acrocentric nature of Chr 21 and it’s small size makes it prone to an event called Robertsonian Translocation whereby two acrocentric chromosomes fuse.

A spectral karyogram of a brain cancer (glioblastoma) illustrating multiple translocation problems and chromosome instability. Credit: Thomas Reid, NCI (CC-BY-NC)
Abnormalities in mitosis also occur and can result in diseases from translocations.