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Fritz R, Edwards L, Jacob R. Osteoporosis in Adult Patients with Intellectual and Developmental Disabilities: Special Considerations for Diagnosis, Prevention, and Management. South Med J 2021; 114:246-251. [PMID: 33787940 DOI: 10.14423/smj.0000000000001231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
As medical care progresses, patients with intellectual and developmental disabilities are living longer and beginning to experience diseases that commonly afflict the aging population, such as osteoporosis. Osteoporosis and resultant fractures increase disability and threaten the independence of this vulnerable population. In addition, the diagnosis, prevention, and management of osteoporosis present unique challenges in these patients. Critical preventive targets include exercise modification, fall prevention, and monitoring for nutrient deficiencies. Commonly used in diagnosis and treatment monitoring, dual-energy x-ray absorptiometry (DXA) scan of the hip and spine may not be feasible, whereas peripheral DXA or computed tomography may be more accessible for patients with physical disabilities. Pharmacological treatment should be tailored to the individual patient, considering factors such as adherence and comorbidities. Finally, bone turnover markers are a noninvasive, cost-effective option for monitoring treatment response in patients who cannot undergo DXA.
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Affiliation(s)
- Rachel Fritz
- From the Division of General Internal Medicine, University of Florida College of Medicine, Jacksonville
| | - Linda Edwards
- From the Division of General Internal Medicine, University of Florida College of Medicine, Jacksonville
| | - Rafik Jacob
- From the Division of General Internal Medicine, University of Florida College of Medicine, Jacksonville
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2
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Bernal-Celestino RJ, León-Hurtado D, Martínez-Leal R. Acceso y morbilidad hospitalaria en personas con trastornos del desarrollo intelectual. ACTA ACUST UNITED AC 2017; 59:408-415. [DOI: 10.21149/8202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 05/12/2017] [Indexed: 11/06/2022]
Abstract
Objetivo. Las personas con trastornos del desarrollo intelectual (TDI) suelen presentar peor estado de salud que la población general. El objetivo de este estudio es evaluar el acceso y la morbimortalidad hospitalaria en los pacientes con TDI y compararla con la población general. Material y métodos. Se realizó un estudio transversal retrospectivo y se compararon los datos de los ingresos y altas hospitalarias entre pacientes con TDI y sin dichos transtornos, en Ciudad Real, España. Resultados. De un total de 51 325 altas, 441 (0.9%) correspondían a personas con TDI. Estas personas presentaban significativamente menos ingresos programados que la población general y menos intervenciones quirúrgicas y, a su vez, más ingresos debidos a enfermedades mentales y del sistema respiratorio. Conclusiones. Las personas con TDI tienen patrones de morbilidad diferentes a los del resto de la población. Además este estudio revela posibles dificultades en el acceso a la atención sanitaria en estas personas.
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Glick NR, Fischer MH. Potential Benefits of Ameliorating Metabolic and Nutritional Abnormalities in People With Profound Developmental Disabilities. Nutr Metab Insights 2017; 10:1178638817716457. [PMID: 35185339 PMCID: PMC8855413 DOI: 10.1177/1178638817716457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/21/2017] [Indexed: 11/20/2022] Open
Abstract
Background: People with profound developmental disabilities have some of the most severe neurological impairments seen in society, have accelerated mortality due to huge medical challenges, and yet are often excluded from scientific studies. They actually have at least 2 layers of conditions: (1) the original disability and (2) multiple under-recognized and underexplored metabolic and nutritional imbalances involving minerals (calcium, zinc, and selenium), amino acids (taurine, tryptophan), fatty acids (linoleic acid, docosahexaenoic acid, arachidonic acid, adrenic acid, Mead acid, plasmalogens), carnitine, hormones (insulinlike growth factor 1), measures of oxidative stress, and likely other substances and systems. Summary: This review provides the first list of metabolic and nutritional abnormalities commonly found in people with profound developmental disabilities and, based on the quality of life effects of similar abnormalities in neurotypical people, indicates the potential effects of these abnormalities in this population which often cannot communicate symptoms. Key messages: We propose that improved understanding and management of these disturbed mechanisms would enhance the quality of life of people with profound developmental disabilities. Such insights may also apply to people with other conditions associated with disability, including some diseases requiring stem cell implantation and living in microgravity.
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Affiliation(s)
- Norris R Glick
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Milton H Fischer
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Burke EA, McCallion P, Carroll R, Walsh JB, McCarron M. An exploration of the bone health of older adults with an intellectual disability in Ireland. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:99-114. [PMID: 27097825 DOI: 10.1111/jir.12273] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/22/2015] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many risk factors have been confirmed for poor bone health among the general population including age, gender and corticosteroid use. There is a paucity of investigation among people with intellectual disability; however, research points to differing risks namely anti-epileptic medication use, Down syndrome and poor behaviour lifestyle. METHODS Data was extracted from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing in Ireland. In total, 753 participants took part, and data was gathered on participants' health status, behavioural health, health screenings and activities of daily living. The prevalence of osteoporosis and related risk factors were specifically examined. RESULTS Overall, 8.1% reported a doctor's diagnosis of osteoporosis with over 20% reporting history of fracture. Risk identified included older age (P < 0.0001), female gender (P < 0.0001), difficulty walking (P < 0.0001) with older age and being female the stronger predictors for osteoporosis, odds ratio = 6.53; 95% confidence interval 2.82-15.11 and odds ratio = 4.58; 95% confidence interval 2.29-9.17, respectively. There was no gender difference regarding the level of fractures; however, epilepsy and anti-epileptic medication were strong predictors. Overall, 11.1% attended for bone screening diagnostics. CONCLUSION Despite low levels of reported doctor's diagnosis of osteoporosis risk factor prevalence was high. Considering the insidious nature of osteoporosis and the low levels of diagnostic screening, prevalence could be possibly higher.
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Affiliation(s)
- E A Burke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- Center for Excellence in Aging and Community Wellness, University at Albany, NY, USA
| | - R Carroll
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - J B Walsh
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - M McCarron
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
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Büchele G, Becker C, Cameron ID, Auer R, Rothenbacher D, König HH, Rapp K. Fracture risk in people with developmental disabilities: results of a large claims data analysis. Osteoporos Int 2017; 28:369-375. [PMID: 27553444 DOI: 10.1007/s00198-016-3733-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Age- and sex-specific fracture rates of 18,000 people with developmental disabilities aged 0-69 years were compared to the general population. Age-standardized incidence of femoral fracture was 4.8- and 7.1-fold higher in women and men, respectively. Comparable fracture risks to the general population occurred 10-15 years earlier in females and 20-40 years earlier in males. INTRODUCTION Previous studies suggested that fracture risks in people with developmental disabilities (DD) may be higher than in people in the general population. However, there are no current sufficiently large studies to compare age- and sex-specific fracture rates of single fracture types. METHODS People with DD and incident fractures were identified by routine data of a health insurance company. Fractures in the general population were derived from the official fracture statistics. Age-specific and age-standardized fracture incidences were analyzed. To compare fracture risks in people with DD with that of the general population incidence ratios were calculated. RESULTS Between 2008 and 2010, 148 femoral fractures and 469 other fractures were observed in nearly 18,000 people with DD aged 0-69 years. The three most frequent fracture types leading to hospital admission were fractures of the femur, lower leg/ankle, and shoulder/arm. For femoral fractures, a particularly high risk was observed in children and adolescents with DD. In adults with DD, the risk of femoral fractures increased with increasing age. Even if the youngest age category was not considered, the age-standardized incidence was 4.8- and 7.1-fold higher in women and men, respectively. For all other fracture types, except fractures of forearm/hand and of pelvis, people with DD had also higher fracture incidences than the general population. CONCLUSIONS People with DD have a high fracture burden. Comparable risks of femoral fracture, for example, occurred about 10-15 years earlier in females and even 20-40 years earlier in males with DD than in the general population.
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Affiliation(s)
- G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - C Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, St Leonards, NSW 2065, Australia
| | - R Auer
- Department of care management, AOK Baden-Württemberg, Presselstr. 19, 70191, Stuttgart, Germany
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - H H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - K Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
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6
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Trinh A, Wong P, Brown J, Hennel S, Ebeling PR, Fuller PJ, Milat F. Fractures in spina bifida from childhood to young adulthood. Osteoporos Int 2017; 28:399-406. [PMID: 27553445 DOI: 10.1007/s00198-016-3742-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED This study assessed the prevalence and types of fractures in spina bifida and examined risk factors for fracture. Fracture prevalence was highest in childhood and reduced in adolescence and young adulthood. The importance of maintaining mobility is highlighted by the increased risk of fracture in those who are non-ambulatory. INTRODUCTION The aims of this study are to study the prevalence and types of fractures according to age group in spina bifida and examine risk factors associated with fracture. METHODS This is a retrospective cohort study of 146 individuals with spina bifida aged 2 years or older who attended the paediatric or adult spina bifida multidisciplinary clinic at a single tertiary hospital. RESULTS Median age at which first fracture occurred was 7 years (interquartile range 4-13 years). Fracture rates in children (ages 2-10), adolescents (ages 11-18) and adults (age > 18) were 10.9/1000 (95 % confidence interval 5.9-18.3), 5.4/1000 (95 % CI 1.5-13.8) and 2.9/1000 (95 % CI 0.6-8.1) patient years respectively. Childhood fractures predominantly involved the distal femur and femoral shaft; these fractures were rarely seen in adulthood. Non-ambulatory status was associated with a 9.8 times higher risk of fracture compared with ambulatory patients (odds ratio 9.8, p = 0.016, 95 % CI 1.5-63.0). Relative risk of re-fracture was 3.1 (95 % CI 1.4-6.8). Urological intervention with intestinal segments was associated with renal calculi (p = 0.037) but neither was associated with fracture. CONCLUSIONS The risk of fracture is lower in adults compared with children with spina bifida. The predominant childhood fracture affects the distal femur, and immobility is the most significant risk factor for fracture. Clinical factors contributing to fracture risk need to be elucidated to enable selection of patients who require investigation and treatment of osteoporosis.
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Affiliation(s)
- A Trinh
- Department of Endocrinology, Monash Health, 246 Clayton Rd, Clayton, Victoria, 3168, Australia.
- Hudson Institute of Medical Research, Clayton, Melbourne, Australia.
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - P Wong
- Department of Endocrinology, Monash Health, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
- Hudson Institute of Medical Research, Clayton, Melbourne, Australia
| | - J Brown
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Paediatrics, Monash Health, Melbourne, Australia
| | - S Hennel
- Developmental Paediatrics, Monash Children's, Monash Health, Melbourne, Australia
- Victorian Paediatric Rehabilitation Service, Monash Children's, Monash Health, Melbourne, Australia
| | - P R Ebeling
- Department of Endocrinology, Monash Health, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - P J Fuller
- Department of Endocrinology, Monash Health, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
- Hudson Institute of Medical Research, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - F Milat
- Department of Endocrinology, Monash Health, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
- Hudson Institute of Medical Research, Clayton, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
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Renfro M, Maring J, Bainbridge D, Blair M. Fall Risk Among Older Adult High-Risk Populations: a Review of Current Screening and Assessment Tools. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0181-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Neumeyer AM, O'Rourke JA, Massa A, Lee H, Lawson EA, McDougle CJ, Misra M. Brief report: bone fractures in children and adults with autism spectrum disorders. J Autism Dev Disord 2015; 45:881-7. [PMID: 25193141 DOI: 10.1007/s10803-014-2228-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Peripubertal boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. However, it is not clear whether lower BMD in ASD results in an increased fracture rate. This study examined the rate of fractures in children and adults with and without ASD using a national database of emergency room visits (Nationwide Emergency Department Sample). A higher odds ratio for hip fractures in children and young adults (3-22 years) as well as older adults (23-50 years) with ASD than those without ASD, and a higher odds ratio for forearm and spine fractures in women ages 23-50 with ASD were found. Further studies are necessary to better understand the decreased bone density in ASD and its implications for fracture development.
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Affiliation(s)
- Ann M Neumeyer
- Lurie Center for Autism, Massachusetts General Hospital and Harvard Medical School, One Maguire Road, Lexington, MA, USA,
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Vice MA, Nahar VK, Ford MA, Bass MA, Johnson AK, Davis AB, Biviji-Sharma R. Risk Factors for Low Bone Mineral Density in Institutionalized Individuals with Developmental Disabilities. Health Promot Perspect 2015; 5:147-52. [PMID: 26290830 DOI: 10.15171/hpp.2015.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/28/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Persons with intellectual/developmental disabilities (IDD) are exposed to several factors, which have been determined as risks for osteoporosis. Many of these individuals are non-ambulatory, resulting in lack of weight bearing activity, which is well established as a major contributor to bone loss. The purpose of this study was to investigate risk factors for low bone mineral density (BMD) in persons with IDD residing in residential facilities. METHODS This cross-sectional study was conducted at an Intermediate Care Facility for individuals with Intellectual and Developmental Disabilities (ICF/IDD). Medical records data were used from 69 individuals, including heal scan T-scores, nutritional, pharmacologic and other risk factors. Chi-Square analysis was used to determine relationships between the variables. RESULTS BMD measures were not significantly associated with age, gender, height, weight, or BMI for this population (P > 0.05). The association between BMD diagnoses and DSM-IV classification of mental retardation approached significance (P = 0.063). A significant association was found with anti-seizure medication (P = 0.009). CONCLUSION Follow-up studies should focus on how supplementation and medication changes may or may not alter BMD. Persons with IDD are experiencing longer life expectancies, and therefore, studies ascertaining information on diseases associated with this aging population are warranted.
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Affiliation(s)
- Michael A Vice
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, USA
| | - Vinayak K Nahar
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, USA
| | - M Allison Ford
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, USA
| | - Martha A Bass
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, USA
| | - Andrea K Johnson
- Department of Health and Human Performance, Health, and Behavioral Sciences, College of Education, The University of Tennessee at Martin, USA
| | - Ashton B Davis
- School of Medicine, University of Mississippi, Jackson, USA
| | - Rizwana Biviji-Sharma
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, USA
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Courtenay K, Murray A. Foot Health and Mobility in People With Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2015. [DOI: 10.1111/jppi.12105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ken Courtenay
- Department of Intellectual Disabilities; Barnet, Enfield and Haringey Mental Health NHS Trust; London UK
| | - Anita Murray
- Greenwich Community Services; Oxleas Foundation Trust; London UK
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Frighi V, Morovat A, Stephenson MT, White SJ, Hammond CV, Goodwin GM. Vitamin D deficiency in patients with intellectual disabilities: prevalence, risk factors and management strategies. Br J Psychiatry 2014; 205:458-64. [PMID: 25257061 DOI: 10.1192/bjp.bp.113.143511] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency. AIMS To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments. METHOD Cross-sectional observational study followed by treatment evaluation. Results Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels. CONCLUSIONS Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.
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Affiliation(s)
- Valeria Frighi
- Valeria Frighi, MD, Department of Psychiatry, University of Oxford and Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Alireza Morovat, PhD, FRCPath, Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford; Matthew T. Stephenson, FRCPsych, MSysPsych, Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Sarah J. White, RGN, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford; Christina V. Hammond, BSc, Guy M. Goodwin, Dphil, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alireza Morovat
- Valeria Frighi, MD, Department of Psychiatry, University of Oxford and Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Alireza Morovat, PhD, FRCPath, Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford; Matthew T. Stephenson, FRCPsych, MSysPsych, Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Sarah J. White, RGN, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford; Christina V. Hammond, BSc, Guy M. Goodwin, Dphil, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Matthew T Stephenson
- Valeria Frighi, MD, Department of Psychiatry, University of Oxford and Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Alireza Morovat, PhD, FRCPath, Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford; Matthew T. Stephenson, FRCPsych, MSysPsych, Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Sarah J. White, RGN, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford; Christina V. Hammond, BSc, Guy M. Goodwin, Dphil, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sarah J White
- Valeria Frighi, MD, Department of Psychiatry, University of Oxford and Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Alireza Morovat, PhD, FRCPath, Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford; Matthew T. Stephenson, FRCPsych, MSysPsych, Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Sarah J. White, RGN, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford; Christina V. Hammond, BSc, Guy M. Goodwin, Dphil, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Christina V Hammond
- Valeria Frighi, MD, Department of Psychiatry, University of Oxford and Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Alireza Morovat, PhD, FRCPath, Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford; Matthew T. Stephenson, FRCPsych, MSysPsych, Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Sarah J. White, RGN, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford; Christina V. Hammond, BSc, Guy M. Goodwin, Dphil, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Guy M Goodwin
- Valeria Frighi, MD, Department of Psychiatry, University of Oxford and Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Alireza Morovat, PhD, FRCPath, Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford; Matthew T. Stephenson, FRCPsych, MSysPsych, Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Sarah J. White, RGN, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford; Christina V. Hammond, BSc, Guy M. Goodwin, Dphil, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, Oxford, UK
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13
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Jasien J, Daimon CM, Maudsley S, Shapiro BK, Martin B. Aging and bone health in individuals with developmental disabilities. Int J Endocrinol 2012; 2012:469235. [PMID: 22888344 PMCID: PMC3408668 DOI: 10.1155/2012/469235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/17/2012] [Indexed: 02/02/2023] Open
Abstract
Low bone mass density (BMD), a classical age-related health issue and a known health concern for fair skinned, thin, postmenopausal Caucasian women, is found to be common among individuals with developmental/intellectual disabilities (D/IDs). It is the consensus that BMD is decreased in both men and women with D/ID. Maintaining good bone health is important for this population as fractures could potentially go undetected in nonverbal individuals, leading to increased morbidity and a further loss of independence. This paper provides a comprehensive overview of bone health of adults with D/ID, their risk of fractures, and how this compares to the general aging population. We will specifically focus on the bone health of two common developmental disabilities, Down syndrome (DS) and cerebral palsy (CP), and will discuss BMD and fracture rates in these complex populations. Gaining a greater understanding of how bone health is affected in individuals with D/ID could lead to better customized treatments for these specific populations.
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Affiliation(s)
- Joan Jasien
- Metabolism Unit, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224, USA
- Department of Neurology and Neurodevelopment, Kennedy Krieger Institute, 801 N. Broadway, Baltimore, MD 21224, USA
- *Joan Jasien:
| | - Caitlin M. Daimon
- Metabolism Unit, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224, USA
| | - Stuart Maudsley
- Receptor Pharmacology Unit, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224, USA
| | - Bruce K. Shapiro
- Department of Neurology and Neurodevelopment, Kennedy Krieger Institute, 801 N. Broadway, Baltimore, MD 21224, USA
| | - Bronwen Martin
- Metabolism Unit, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224, USA
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Haveman M, Perry J, Salvador-Carulla L, Walsh PN, Kerr M, Van Schrojenstein Lantman-de Valk H, Van Hove G, Berger DM, Azema B, Buono S, Cara AC, Germanavicius A, Linehan C, Määttä T, Tossebro J, Weber G. Ageing and health status in adults with intellectual disabilities: results of the European POMONA II study. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2011; 36:49-60. [PMID: 21314593 DOI: 10.3109/13668250.2010.549464] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND POMONA II was a European Commission public health-funded project. The research questions in this article focus on age-specific differences relating to environmental and lifestyle factors, and the 17 medical conditions measured by the POMONA Checklist of Health Indicators (P15). METHOD The P15 was completed in a cross-sectional design for a stratified sample of 1,253 adults with ID across 14 European member states. RESULTS Older people (55+) were more likely to live in larger residential homes. Rates of smoking and use of alcohol were lower than in the general population but were higher with older age. More than 60% of older adults had a sedentary lifestyle. Cataract, hearing disorder, diabetes, hypertension, osteoarthritis/arthrosis, and osteoporosis were positively associated with advancing age; allergies and epilepsy, negatively associated. CONCLUSIONS Some evidence of health disparities was found for older people with ID, particularly in terms of underdiagnosed or inadequately managed preventable health conditions.
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Affiliation(s)
- Meindert Haveman
- Faculty of Rehabilitation Sciences, University of Dortmund, Germany.
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Srikanth R, Cassidy G, Joiner C, Teeluckdharry S. Osteoporosis in people with intellectual disabilities: a review and a brief study of risk factors for osteoporosis in a community sample of people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:53-62. [PMID: 21129056 DOI: 10.1111/j.1365-2788.2010.01346.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The population of people with intellectual disabilities (ID) is increasing and their health needs impact on primary and secondary healthcare specialities. One important aspect of their physical health is bone health as people with ID have increased risk factors associated with osteoporosis. It has been identified that this population has an increased prevalence of low bone mineral density (BMD), osteoporosis and osteopenia. The main contributory factors for low BMD are age, use of antiepileptics, immobility and diagnosis of Down's syndrome. METHODS A literature search of electronic databases was undertaken. Studies that included people with ID were reviewed for the prevalence of osteoporosis and osteopenia. A cross-sectional survey was conducted in a community sample (n = 149) to screen for risk factors for osteoporosis. RESULTS The majority of studies identified increased prevalence of osteoporosis and osteopenia with associated low BMD. In most studies individuals with ID presented with more than two risk factors. In our survey, we identified an increased prevalence of risk factors associated with osteoporosis, namely use of antiepileptics (64%), immobility (23%), history of falls (20%) and fractures (11%). We found that 54% of our sample fulfilled the criteria for screening. Of those who went on to have scans, 55% had osteoporosis and 33% had osteopenia. CONCLUSION We conclude that we should be screening for the risk factors associated with low BMD in adults with ID. If these are present further investigations should take place and those found to have osteoporosis and osteopenia should have treatment at an early stage to prevent morbidity and improve their quality of life.
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Affiliation(s)
- R Srikanth
- Tees, Esk and Wear Valleys NHS Foundation Trust, Child and Adolescent Learning Disability psychiatry, Durham, UK.
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Willgoss TG, Yohannes AM, Mitchell D. Review of risk factors and preventative strategies for fall-related injuries in people with intellectual disabilities. J Clin Nurs 2010; 19:2100-9. [PMID: 20569280 DOI: 10.1111/j.1365-2702.2009.03174.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To explore the risk factors and management of falls in people with intellectual disabilities and develop evidence-based recommendations. BACKGROUND Falling is a common cause of physical injury and impaired quality of life in people with intellectual disability. Risk factors for falls and falls prevention have been extensively researched in the general population but there is a paucity of evidence specific to people with intellectual disabilities. DESIGN Systematic review and comment. METHOD Publications on the prevalence, risk factors and prevention of falls in people with intellectual disability were sought. We searched MEDLINE, CINAHL, PsychInfo and AMED (1 January 2000-7 January 2009). Search terms used to extract the relevant articles were 'intellectual disability', 'falls', 'injury', 'fractures', 'risk factors' and 'prevention'. RESULTS Seven articles met the inclusion criteria. Up to 57% of people with intellectual disabilities experienced a fall. Falling was the cause of 50-62% of all recorded injuries. Risk factors for falls in people with intellectual disabilities may include older age, impaired mobility, epilepsy and behavioural problems. There was a paucity of evidence for intervention strategies identified. CONCLUSION There is a lack of evidence for falls management in people with intellectual disabilities. Findings suggest that falls are a common cause of injury, institutionalisation and impaired quality of life in people with intellectual disabilities. Environmental safety, careful medical management and exercise interventions may play an important role in minimising fall-related injuries. Further research is needed to explore risk factors for falls and falls management in this vulnerable group. RELEVANCE TO CLINICAL PRACTICE Early identification of the risk factors and prevention of falls will inform nurses and other healthcare professionals those who are at most risk and how to minimise injury in people with an intellectual disability. A multi-model approach of comprehensive assessment and tailored intervention are worthy of endeavour.
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Affiliation(s)
- Thomas G Willgoss
- Department of Health Professions, Elizabeth Gaskell Campus, Manchester Metropolitan University, Manchester M13 0JA, UK.
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Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major Health Risks in Aging Persons With Intellectual Disabilities: An Overview of Recent Studies. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1741-1130.2010.00248.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Leslie WD, Pahlavan PS, Roe EB, Dittberner K. Bone density and fragility fractures in patients with developmental disabilities. Osteoporos Int 2009; 20:379-83. [PMID: 18629564 DOI: 10.1007/s00198-008-0678-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 05/23/2008] [Indexed: 11/27/2022]
Abstract
UNLABELLED We investigated prior fractures, osteoporosis risk factors, and bone mineral density (BMD) in 107 institutionalized adults with developmental disabilities. We found a very high prevalence of BMD in the osteoporotic range and a significant correlation between lower BMD and prior fragility fractures. INTRODUCTION The purpose of this study was to investigate factors contributing to osteoporosis and fragility fractures among developmentally disabled adults. METHODS Adults from a residential center participated in a prospective study in which bone mineral density (BMD) at the forearm and heel were measured with a portable X-ray densitometer. Prior fragility fractures were identified from chart review. RESULTS Among 107 participants, 84 (78.5%) had a measurement within the osteoporotic range. The heel was more severely abnormal (mean T-score -3.1 +/- 1.5) than the forearm (-1.6 +/- 1.3, p < .0.0001). Radiographically confirmed prior fragility fractures (17 [16.3%]) were associated with lower heel (p = 0.0155) and forearm (p = 0.0172) T-scores. In multiple regression analysis, there were independent associations between forearm BMD and prior fragility fractures (p = 0.0126) and between heel BMD and prior fragility fractures (p = 0.0291). The odds ratio for prior fracture increased by 2.02 (95% CI 1.12-3.64) for each standard deviation (SD) decrease in heel T-score and by 2.39 (95% CI 1.08-5.32) for each SD decrease in forearm T-score. CONCLUSIONS We found a very high prevalence of osteoporotic BMD measurements in institutionalized adults with developmental disabilities. Lower heel and forearm BMD measurements were significantly and independently associated with prior fragility fractures in this population.
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Affiliation(s)
- W D Leslie
- Section of Nuclear Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
BACKGROUND Injury prevention among individuals with disabilities is understudied. We compared the patterns of medically treated injuries among US adults with and without disabilities for clues to prevention. METHODS We used nationally representative data from the 2004-2005 National Health Interview Survey to compare medically attended injuries within the past 3 months among noninstitutionalized adults in the United States with no disabilities, moderate disabilities, and severe disabilities. The association between disability and injuries was examined in logistic regression analysis, taking into account sociodemographic factors. RESULTS The 3-month cumulative incidence of injuries was 2.3% (95% confidence interval [CI] = 2.2%-2.4%) among adults with no disabilities, 3.8% (3.4%-4.2%) among adults with moderate disabilities, and 5.6% (4.9%-6.3%) among adults with severe disabilities. Falls were the leading mechanism of injury regardless of disability status, and were even more common in the severely or moderately disabled adults (68% and 47% respectively, compared with 28% among those without disabilities). The setting of the injury also differed with disability status. For the severely disabled, 57% (CI = 52%-62%) of injury episodes occurred at home, compared with only 32% (28%-37%) for the moderately disabled and 23% (21%-25%) for adults with no disabilities. CONCLUSIONS Adults with disabilities are at an increased risk for injury. Programs specifically directed toward injury prevention may benefit adults with disabilities.
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Vanlint S, Nugent M, Durvasula S, Downs J, Leonard H. A guide for the assessment and management of vitamin D status in people with intellectual disability (developed as an AADDM Working Party initiative). JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2008; 33:184-188. [PMID: 18569406 DOI: 10.1080/13668250802015625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Simon Vanlint
- Discipline of General Practice, University of Adelaide, SA, Australia.
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Prevalence of osteoporosis in community-dwelling individuals with intellectual and/or developmental disabilities. J Am Med Dir Assoc 2008; 9:109-13. [PMID: 18261703 DOI: 10.1016/j.jamda.2007.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 09/21/2007] [Accepted: 09/24/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Measure central bone mineral density (BMD) in community-dwelling individuals with intellectual and/or developmental disabilities. DESIGN A cross-sectional study. SETTING A regional center providing outpatient medical, residential, and day activity services for individuals with intellectual and/or developmental disabilities. PARTICIPANTS Documented BMD results were obtained for 298 community-dwelling individuals with intellectual and/or developmental disabilities. MEASUREMENTS BMD by central dual-energy x-ray absorptiometry (DXA) on the participant's spine, converted into T-scores categories using CDC guidelines (T < or = -2.5 [osteoporotic]; -2.5 > T < -1.0 [osteopenic]; > or = -1.0 [normal]). Comparisons were made using multiple regression to determine significant independent risk factors for low BMD. RESULTS Significant predictors were noted in the rates of osteoporosis attributable to subject age, race, and level of ambulation. No gender differences were noted for the rate of osteoporosis in this community sample of individuals with intellectual and/or developmental disabilities, nor were any differences noted for varying levels of mental retardation. Diagnostic differences were significant only for those individuals with a diagnosis of metabolic error, who had a significantly lower rate of osteoporosis than the rest of the study population. CONCLUSION This study's findings regarding age, race, and level of ambulation are consistent with those of previous studies using an intellectually and/or developmentally disabled population as well as the general population at large. Our finding that the rate of osteoporosis among disabled males is higher than for males in the general population suggests a possible case-finding deficit for asymptomatic males in the general population. It is also interesting that the only diagnostic category observed to be statistically different from the group in general was metabolic error, a finding that warrants further investigation.
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Assessment, Intervention, and Prevention of Falls in Elders With Developmental Disabilities. TOPICS IN GERIATRIC REHABILITATION 2008. [DOI: 10.1097/01.tgr.0000311406.01555.e0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Watson KC, Lentz MJ, Cain KC. Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities. Womens Health Issues 2007; 16:346-52. [PMID: 17188217 PMCID: PMC1899250 DOI: 10.1016/j.whi.2006.09.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 09/26/2006] [Accepted: 09/26/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE We sought to evaluate any association between incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate (DMPA) and/or anti-epileptic drugs (AEDs) among women and girls with developmental disabilities. METHODS Cross-sectional population-based observational study of all noninstitutionalized females with developmental disabilities age >/=13 who received fee-for-service Medicaid in Washington State during 2002 (n = 6,773), using administrative data. MAIN FINDINGS In a sample of 6,773 females, 140 women (2%) had an osteoporotic fracture during 2002. Among 340 users of DMPA, 13 (3.8%) had an osteoporotic fracture with an odds ratio of 2.4 (95% confidence interval [CI], 1.3-4.4) for fracture compared to nonusers. Among 1,909 users of AEDs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (95% CI, 1.3-2.6) for fracture compared to nonusers. We controlled for use of drugs (DMPA or AEDs), age and race (as white or other racial and ethnic groups). CONCLUSIONS Use of either AEDs or DMPA by women with developmental disabilities is associated with significantly increased incidence of fracture. Women and girls who have developmental disabilities may be poor candidates for DMPA use owing to increased risk of fractures. Further research is indicated to 1) determine the specific risks profile of DMPA for this population, 2) explore alternative means of managing significant menstrual problems and contraceptive needs in this population, and 3) screen current and previous users of DMPA and chronic users of AEDs for osteoporosis risk, regardless of age.
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Affiliation(s)
- Kathleen C. Watson
- Lecturer, Biobehavioral Nursing and Health Systems, School of Nursing, and Director, Adults and Elders Project, Center on Human Development and Disability University of Washington, Box 357266, Seattle, WA 98195-7266 Phone 206 616 1660, Fax 206 543 4771
| | - Martha J. Lentz
- Research Professor, Biobehavioral Nursing and Health Systems, and Research Consultant, Office for Nursing Research, School of Nursing, University of Washington, Box 357261, Seattle, WA 98195-7261 Phone 206 543 4091, Fax 206 616 5147
| | - Kevin C. Cain
- Research and Statistical Consultant, Office for Nursing Research, School of Nursing, University of Washington, Box 357232, Seattle, WA 98195-7232 Phone 206 221 2410 Fax 206 685 9264
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Vanlint S, Nugent M. Vitamin D and fractures in people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2006; 50:761-7. [PMID: 16961705 DOI: 10.1111/j.1365-2788.2006.00841.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND People with intellectual disability (ID) are thought to be at an increased risk of fractures. The extent of this increase in risk has been incompletely documented in the literature, and the underlying reasons remain to be elucidated. METHODS The aims of our study were to document the vitamin D status and fracture incidence in an intellectually disabled population, to test for associations between vitamin D status and possible risk factors for reduced vitamin D levels, and to determine the efficacy of oral vitamin D supplementation in restoring appropriate vitamin D levels in those found to be vitamin D insufficient. A 5-year retrospective audit of fractures in 337 individuals with ID receiving health care at a residential facility was performed. Data analysed included age, gender, mobility, dietary status, incident fractures, medications and 25-hydroxyvitamin D levels. Vitamin D insufficient individuals received oral vitamin D supplementation, and had repeat testing to assess treatment efficacy. RESULTS In total, 57% of individuals tested were found to be vitamin D insufficient. Vitamin D insufficiency was strongly correlated with reduced mobility (P < 0.001) and difficulty with consuming solids (P < 0.001). However, the correlation between vitamin D levels and fractures was not significant (P = 0.3). Oral vitamin D supplementation using cholecalciferol (vitamin D3) 100,000 IU every 4 months was effective in correcting vitamin D insufficiency. Sixty-eight fractures occurred over the study period in 52 individuals, a rate of 1 fracture every 23.8 person years. A total of 55% of these fractures involved the extremities. Fractures were more common in men than in women. Peripheral fractures (hand, foot, wrist, ankle) accounted for 54% of all fractures, and were particularly prevalent in the most mobile individuals. CONCLUSIONS Fractures and vitamin D insufficiency are relatively common in people with ID. This study did not find a significant association between vitamin D insufficiency and fractures in the study population. Oral vitamin D supplementation is effective in restoring normal vitamin D levels, and should be considered routinely for those at the highest risk.
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Affiliation(s)
- S Vanlint
- Discipline of General Practice and Spencer Gulf Rural Health School, University of Adelade, South Australia, Australia.
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Wagemans AMA, Cluitmans JJM. Falls and Fractures: A Major Health Risk for Adults with Intellectual Disabilities in Residential Settings. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2006. [DOI: 10.1111/j.1741-1130.2006.00066.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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