Peripheral bone density measurement: An interdisciplinary initiative for improving health outcomes for people with learning disabilities

Abstract

Challenges exist in respect of people with intellectual disabilities who, with the increasing life expectancy, have a growing risk of age-related degenerative conditions. Changes in bone health are associated with increasing age and the bone health of people who have intellectual disabilities is well documented in the literature as being poor in comparison to the general population. A heel scan clinic was set up in an intellectual disability service as a service improvement initiative. There were 12 females and 17 males scanned using a heel scanner. Only 3 (10.3%) people with intellectual disabilities were in the normal bone mineral density (BMD) range. Peripheral BMD screening for people has been shown to provide important information about the bone health of people with intellectual disabilities which has prompted further treatment by general practitioners and has the potential to provide an accessible way to obtain information on the bone health of people with intellectual disabilities.

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

“…The current study's revelation that a significant proportion, 65%, had never undergone DXA assessment, the gold standard for diagnosis, is concerning, even if DXA is not always suitable for this cohort. Other options must be considered and embraced, such as QUS, which has been noted as acceptable to people with intellectual disability (Burke et al, 2019(Burke et al, , 2020Walsh et al, 2022) to better ensure access and comprehensive evaluation. Annual health assessment ought to include a comprehensive health history, including family history where possible, bone health assessment including height, weight, vitamin D and K, body shape or any change in posture, bowel health status and nutritional status; all need to be assessed, when concerns are raised bone health profile and markers ought to be ordered, including vitamin D, calcium, phosphate, albumin, alkaline phosphatase, c-telopeptide and then DXA where possible.…”

“…All too often, diagnosis of poor bone health is dependent on dual‐energy X‐ray absorptiometry (DXA) scanning, an assessment that may prove too difficult for people with intellectual disability or indeed may not be offered (Frighi et al, 2019; Fritz et al, 2021; Walsh et al, 2022). There is often a lack of access to this type of assessment for individuals with intellectual disability, particularly with mobility difficulties as well as difficulty in complying with instruction; they may experience fear, present with behaviours that challenge or may simply be too scared with an unfamiliar environment (Brodtkorb et al, 2016; Gillis et al, 2009; Iacono et al, 2014), factors that pose challenges for diagnosis.…”

“…If people do not engage in DXA, there is a risk that they will not receive treatment. Alternate means of assessment are established; however, they are not widely used or recognised by clinicians (Burke et al, 2018; Walsh et al, 2022). FRAX™, a validated recognised assessment tool utilised by healthcare professionals to establish bone health and risk of fracture, is also widely used in healthcare.…”