Aging and Bone Health in Individuals with Developmental Disabilities

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.

Characteristics Associated With Bone Mineral Density Screening in Adults With Intellectual Disabilities

“…13,14 While studies of this population are indeed small (in general, 100 to 500 individuals participating), this indicates a heightened need for concern about osteoporosis in men. 15 In addition, osteoporosis and osteopenia often occur at younger ages for people with intellectual disability than the general population. Indeed, there have been some studies indicating a first fracture occurring in the early 40s among people with intellectual disability.…”

“…Indeed, there have been some studies indicating a first fracture occurring in the early 40s among people with intellectual disability. 2,13,15 For the general population, the US Preventive Services Task Force recommends starting screening at Ն65 years for women and younger for women with risk factors; at this time there is insufficient evidence to recommend screening for men. 16 However, recommendations vary regarding bone density screening for people with intellectual disability.…”

Vitamin D Adequacy and Improvements of Comorbidities in Persons with Intellectual Developmental Disabilities

“…In adults, it leads to osteomalacia, muscular weakness, falls, and fractures [62][63][64][65][66][67][68][69]. Compared with the healthy population, people with MCDD have more comorbidities, including osteomalacia [9,70] and osteoporosis [71][72][73], and increased incidence of falls and fractures [74][75][76].…”

“…Treatment with vitamin D improved sway and decreased the incidence of falls in the elderly [78]. People with MCDD often have osteomalacia [9], osteopenia, or osteoporosis [70] and low bone mass [33,79]; collectively, all of these increase fracture risks. Having strong bones and good neuromuscular control are the key to minimizing falls and fractures.…”

Orthopaedic Care Coordination for the Intellectually and Developmentally Disabled Adult in the Residential Care Setting

“…Intellectually and developmentally disabled (I/DD) adults are living longer and are facing the same challenges associated with aging that other elderly face. In particular, this population is often at increased risk for osteoporosis related to immobility, and therefore, is prone to pathological fractures requiring treatment in the acute care setting ( Jasien, Daimon, Maudsley, Shapiro, & Martin, 2012 ). Although the orthopaedic nurse is an expert when caring for the orthopaedic patient, caring for the I/DD patient may be frustrating and Orthopaedic Care Coordination for the Intellectually and Developmentally Disabled Adult in the Residential Care Setting…”