Men's Bones Matter Too, a Cross Sectional Study Examining Bone Health among Men with Intellectual Disability in Ireland.

Abstract

Globally between 30-40% of all osteoporotic fractures occur among men, with a quarter of all hip fractures, the most serious complication of osteoporosis, occurring in men. Among men of 50 years of age or older, osteoporotic fracture risk reaches an alarming 20%. What is of great concern is that associated mortality is greater among men when compared with women. For hip fractures specifically, mortality for men is two to three times that in women which may be attributed to the fact that osteoporosis is often considered a “women’s disease”. Of great concern is that there is a paucity of bone health investigation among men with intellectual disability. In the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing, objective bone status of 244 men was measured using a quantitative ultrasound. Participant’s also self-reported doctor’s diagnosis of health conditions including osteoporosis, medication and fracture history with the assistance of key workers/family. Ethical approval for the study was obtained from the Faculty of Health Sciences Trinity College and all participating service providers. Overall, 70.9% of men presented with poor bone health, with 57.8% taking at least one medication that contributed to osteoporosis/osteopenia. Men had a high prevalence of fracture (21.7%) despite this less than 18% had attended bone health screening. In light of these findings, it is time for the spotlight to focus on men’s bone health and for healthcare professionals to realise how ‘at risk’ of osteoporosis are men with intellectual disability. Projections place men on a trajectory of continuous increased risk of fracture in comparison to women.

Ageing, osteoporosis and intellectual disability; risks differ, and diagnosis can be missed

“…It is increasingly recognised and of urgent concern that osteoporosis/osteopenia (poor bone health) is underdiagnosed and undertreated in the older population of people with intellectual disability (Burke et al, 2019(Burke et al, , 2021Fritz et al, 2021;Jasien et al, 2012;Nguyen et al, 2004;Winterhalder et al, 2022). In fact, Nguyen et al (2004) report up to 75% of women and 90% of men with increased risk of poor bone health are not investigated, and they go on to report that more than 75% who are diagnosed are not treated.…”

“…International studies suggest that people with intellectual disability have an increased loading of risks for poor bone health (Fritz et al, 2021;Lin et al, 2015;Srikanth et al, 2011). Indeed the prominent risks may differ and may not be factors that are commonly recognised or considered during the assessment of people with intellectual disability (Burke et al, 2021;Winterhalder et al, 2022).…”

“…International studies suggest that people with intellectual disability have an increased loading of risks for poor bone health (Fritz et al, 2021; Lin et al, 2015; Srikanth et al, 2011). Indeed the prominent risks may differ and may not be factors that are commonly recognised or considered during the assessment of people with intellectual disability (Burke et al, 2021; Winterhalder et al, 2022). Factors such as high levels of antiepileptic medication use, for example, phenytoin or sodium valporate, a high prevalence of early menopause, failure to reach optimal bone mass as in the case of those with Down syndrome, complex mobility issues, multiple health conditions or, syndrome specific complexity, for example, Prader−Willis syndrome (Burke et al, 2021, 2017, 2018; Frighi et al, 2019) all can lead to poor bone health; however these are frequently not considered.…”

“…Indeed the prominent risks may differ and may not be factors that are commonly recognised or considered during the assessment of people with intellectual disability (Burke et al, 2021; Winterhalder et al, 2022). Factors such as high levels of antiepileptic medication use, for example, phenytoin or sodium valporate, a high prevalence of early menopause, failure to reach optimal bone mass as in the case of those with Down syndrome, complex mobility issues, multiple health conditions or, syndrome specific complexity, for example, Prader−Willis syndrome (Burke et al, 2021, 2017, 2018; Frighi et al, 2019) all can lead to poor bone health; however these are frequently not considered. A possible explanation for this is the fact that no policy guidelines for osteoporosis/osteopenia assessment among people with intellectual disability exist, in fact considering that people with intellectual disability frequently present atypically, have multiple complex health needs and complex challenges with communication, a disparity exists in what to assess and when to assess.…”