Osteoporosis

What is osteoporosis?

Osteoporosis is a skeletal condition characterised by low bone mineral density (bone mass) and a disorder in the structure of bone tissue. This makes the bone more brittle and makes broken bones (fractures) more likely. It can result in the collapse or fracture of vertebrae, and spinal deformation.

The most common osteoporotic fractures are fractures of the vertebrae, wrist and hip. Two thirds of vertebral fractures occur spontaneously, in other words as a result of minor events. ³⁵³

What are the complaints associated with osteoporosis?

Osteoporosis is a condition that is not, in itself, associated with any complaints. Compressed vertebrae, even though they often do not result in symptoms, may be associated with chronic back pain and a general deterioration in quality of life. In some people, the deformation and shortening of the spine will be the only sign of vertebral fractures. Wrist and hip fractures are usually caused by falls. They are painful.

Pain, particularly in people who are unable to communicate effectively, may be expressed as changes in behaviour.

How common is osteoporosis in the general population?

Osteoporosis is seen in 0.9% of the general population (0.19% of men and 1.6% of women). The number of people with osteoporosis increases with age, and much more sharply in women than in men. ³⁵³

How common is osteoporosis in people with intellectual disabilities?

Osteoporosis is seen in 8 to 21% of the entire population of people with intellectual disabilities. ^{354 355 356}

The GOUD survey found reduced bone density in 44% of older Dutch people with intellectual disabilities. Women, older people, people with a more severe intellectual disability, people with limited mobility, people who use anti-epileptics, and people with a low BMI are more likely to have osteoporosis. ⁵⁸⁹

Other Dutch research has shown that one-fifth of post-menopausal women living in a care setting for people with intellectual disabilities fail to consume the daily amount of calcium required by the 'Osteoporosis' standard published by the Dutch College of General Practitioners. Bone quality is unsatisfactory in one third of postmenopausal women and this is associated with impaired functioning and immobility. ⁵⁹⁰

The European POMONA questionnaire survey of a random sample of 1269 adults with intellectual disabilities found a prevalence rate for osteoporosis of 5.5%. ³⁵⁷

An Australian study found a prevalence rate for osteoporosis of 6% in women and 20% in men. ³⁵⁴

A more recent questionnaire survey of 2540 people with intellectual disabilities (in which questionnaires were answered by carers and parents) found that 9% of the sample had osteoporosis. ³⁵⁸

A survey of people with intellectual disabilities living in the open population found a prevalence rate for osteoporosis of 17.1% and reduced bone density in 51.0%. ³⁵⁵

Another survey of adults with intellectual disabilities living in the open population found a prevalence rate of 21% for reduced bone density. ³⁵⁶

A study of post-menopausal women with intellectual disabilities residing in an institution identified 82% with osteoporosis ³⁵⁹ ; the rate for men was 34%. ³⁶⁰

A range of risk factors for osteoporosis have been investigated in people with intellectual disabilities. In 96 people (children and adults) with epilepsy, 58.3% had low bone density and 25% osteoporosis. They had low bone density significantly more often than the control group of 63 people without epilepsy. Risk factors for low bone density were: inability to walk independently, severe intellectual disability, prolonged treatment with medication and low levels of physical activity. ³⁶¹

Hypogonadism and short body length have also been identified as risk factors for osteoporosis. ³⁶²

People with reduced mobility and intellectual disabilities are at high risk of osteoporosis, even when they consume adequate amounts of calcium. ³⁶²
Children with severe spasticity have an increased risk (77%) of osteoporosis. Risk factors here are nutritional problems, poor mobility, previous fractures, the use of anti-epileptics and low levels of body fat. ³⁶³

People with Down syndrome are more likely to have osteoporosis. ^{356 364 365}

An English study found the following risk factors for osteoporosis: the use of anti-epileptics, immobility, a history of falls and a history of fractures. ³⁶⁶

Irish research has shown that the medical diagnosis of osteoporosis is made only infrequently (8.1%) in older people with intellectual disabilities even though the risk factors are widespread and bone fractures are common. ⁵⁹³

0.90% General population 8% to 21% People with intellectual disabilities