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Tang JYM, Luo H, Wong GHY, Lau MMY, Joe GM, Tse MA, Ip P, Wong ICK, Lum TYS. Bone mineral density from early to middle adulthood in persons with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:936-946. [PMID: 30775821 DOI: 10.1111/jir.12608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND While accelerated ageing is recognised among individuals with Down syndrome (DS), the trajectory of their bone health across adulthood remains poorly understood. METHODS This study aimed to determine the age-related loss of bone mineral density (BMD) of the lumbar spine in 128 adults with DS aged 18 to 54 years compared with 723 counterparts without DS. RESULTS Men and women with DS had lower level of BMD than counterparts without DS across age groups. Magnitude of decrement in BMD as reflected in the z-scores was similar between younger and older men with DS. Older women with DS, on the contrary, showed greater decrement in older ages especially in their fourth decade of life. Osteopenia and osteoporosis as defined using age-specific and gender-specific T-scores affected greater number of men with DS (38% and 25%) than women (17% and 17%) aged 40-49 years. CONCLUSIONS Findings supported adults with DS, especially men, to have early bone mineral testing.
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Affiliation(s)
- J Y M Tang
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - H Luo
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - G H Y Wong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - M M Y Lau
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - G M Joe
- Institute of Human Performance, The University of Hong Kong, Hong Kong
| | - M A Tse
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Institute of Human Performance, The University of Hong Kong, Hong Kong
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - I C K Wong
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
- School of Pharmacy, University College London, London, UK
| | - T Y S Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Finlayson J, De Amicis L, Gallacher S, Munro R, Crockett J, Godwin J, Feeney W, Skelton DA. Reasonable adjustments to provide equitable and inclusive assessment, screening and treatment of osteoporosis for adults with intellectual disabilities: A feasibility study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:300-312. [PMID: 30175427 DOI: 10.1111/jar.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/26/2018] [Accepted: 08/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities are a high risk population for developing osteoporosis and fragility fractures, yet they experience barriers to accessing dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD) screening and fracture assessment. Reasonable adjustments are a statutory requirement in the UK, but there is a paucity of evidence-based examples to assist their identification, implementation and evaluation. METHOD Thirty adults with intellectual disabilities underwent DXA BMD screening and fracture risk assessment. Reasonable adjustments were identified and implemented. RESULTS The presence of osteopenia or osteoporosis was detected in 23 out of 29 (79%) participants. Osteoporosis professionals report that 17 of 18 reasonable adjustments identified and implemented are both important and easy to implement. CONCLUSION Adults across all levels of intellectual disabilities can complete DXA BMD screening with reasonable adjustments. Widely implementing these reasonable adjustments would contribute to reducing inequalities in health care for adults with intellectual disabilities.
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Affiliation(s)
- Janet Finlayson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Leyla De Amicis
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stephen Gallacher
- Centre for Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robin Munro
- Department of Rheumatology, Wishaw General Hospital, Lanarkshire, UK
| | | | - Jon Godwin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Wendy Feeney
- Department of Rheumatology, Wishaw General Hospital, Lanarkshire, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Welyczko N. Working with patients with long-term conditions and learning disabilities. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/jokc.2018.3.4.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nikki Welyczko
- Associate Professor, Nursing and Midwifery and Associate Head of School, The Leicester School of Nursing and Midwifery, De Montfort University, Leicester
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Capone GT, Chicoine B, Bulova P, Stephens M, Hart S, Crissman B, Videlefsky A, Myers K, Roizen N, Esbensen A, Peterson M, Santoro S, Woodward J, Martin B, Smith D. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Am J Med Genet A 2017; 176:116-133. [PMID: 29130597 DOI: 10.1002/ajmg.a.38512] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 11/06/2022]
Abstract
Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. The United States Preventive Service Task Force (USPSTF) has developed criteria for prioritizing conditions of public health importance with the potential for providing screening recommendations to improve clinical care. The quality of existing evidence needed to inform clinical guidelines has not been previously reviewed. Using the National Library of Medicine (NLM) database PubMed, we first identified 18 peer reviewed articles that addressed co-occurring medical conditions in adults with DS. Those conditions discussed in over half of the articles were prioritized for further review. Second, we performed detailed literature searches on these specific conditions. To inform the search strategy and review process a series of key questions were formulated a priori. The quality of available evidence was then graded and knowledge gaps were identified. The number of participating adults and the design of clinical studies varied by condition and were often inadequate for answering all of our key questions. We provide data on thyroid disease, cervical spine disease, hearing impairment, overweight-obesity, sleep apnea, congenital heart disease, and osteopenia-osteoporosis. Minimal evidence demonstrates massive gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The development of evidence-based clinical guidance will require an expanded clinical knowledge-base in order to move forward.
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Affiliation(s)
- George T Capone
- Kennedy Krieger Institute, Down Syndrome Clinic & Research Center, Baltimore, Maryland
| | - Brian Chicoine
- Advocate Adult Down Syndrome Center, Park Ridge, Illinois
| | - Peter Bulova
- Montefiore Hospital, Adult Down Syndrome Clinic, Pittsburgh, Pennsylvania
| | - Mary Stephens
- Christiana Care Health System, Adult Down Syndrome Clinic, Wilmington, Delaware
| | - Sarah Hart
- Duke University Medical Center, Durham, North Carolina
| | | | - Andrea Videlefsky
- The Adult Disability Medical Home, Urban Family Practice, Marietta, Georgia
| | | | - Nancy Roizen
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Moya Peterson
- University of Kansas Medical Center, Adults with Down Syndrome Specialty Clinic, Kansas City, Kansas
| | | | - Jason Woodward
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Jane and Richard Thomas Center for Down Syndrome, Cincinnati, Ohio
| | - Barry Martin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Smith
- Children's Hospital of Wisconsin, Down Syndrome Clinic of Wisconsin, Milwaukee, Wisconsin
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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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Drozd M, Clinch C. The experiences of orthopaedic and trauma nurses who have cared for adults with a learning disability. Int J Orthop Trauma Nurs 2015; 22:13-23. [PMID: 26573892 DOI: 10.1016/j.ijotn.2015.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no published empirical research about the experiences of orthopaedic and trauma nurses who have cared for people with a learning disability. However, adults with a learning disability sustain more injuries, falls and accidents than the general population. Because of their increased health needs, there has been a corresponding increase in their numbers attending general/acute hospitals. The 6 Cs is a contemporary framework and has been used to gauge how orthopaedic and trauma nurses rate the Care, Communication, Competence, Commitment, Courage and Compassion for patients with a learning disability in orthopaedic and trauma hospital settings compared to patients without a learning disability. AIM The aim of the study was to explore the experiences of orthopaedic and trauma nurses who have cared for people with a learning disability. DESIGN The study is based on a descriptive survey design and used a questionnaire to elicit data from participants. METHODS A convenience sample of Registered Nurses completed a questionnaire. The study was explained to delegates attending a concurrent session on the topic of acute hospital care for people with a learning disability at a conference and the questionnaire was left on a table for participants to take if they wished. Questionnaires were returned anonymously. FINDINGS Of the participants who had completed the questionnaire 100% (n = 13) had cared for a patient with a learning disability. Using the 6 Cs as a framework suggested that care, communication and competence of nurses were worse for people with a learning disability than for people without a learning disability. Three main themes emerged regarding areas of good practices: (1) promoting a positive partnership with patients and carers; (2) modifying care and interventions; (3) supporting the healthcare team. CONCLUSION There was evidence of good practices within orthopaedic and trauma settings such as the active involvement of family or a paid carer who is known to thepatient and the modification of care and interventions along with specialist advice and support from the Acute Liaison Learning Disability Nurse. There were areas of concern such as the lack of use of Hospital Passports and the inconsistent implementation of reasonable and achievable adjustments. It is unknown if the care for patients with a learning disability is adequate. However, the themes that have emerged accord with the key domains in 'A competency framework for orthopaedic and trauma practitioners' (Royal College of Nursing 2012a, 2012b) and therefore could be considered for inclusion in future orthopaedic and trauma competencies to enable sharing of best practices.
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Affiliation(s)
- Mary Drozd
- University of Wolverhampton, Institute of Health Professions, Gorway Road, Walsall, WS1 3BD, UK.
| | - Christine Clinch
- University of Wolverhampton, Institute of Health Professions, Gorway Road, Walsall, WS1 3BD, UK
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Haider SI, Ansari Z, Vaughan L, Matters H, Emerson E. Health and wellbeing of Victorian adults with intellectual disability compared to the general Victorian population. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4034-4042. [PMID: 24036484 DOI: 10.1016/j.ridd.2013.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 06/02/2023]
Abstract
Multiple measures of health and wellbeing of people with intellectual disability (ID) and the general Victorian population were compared using representative population level data. The sample consisted of adults with ID (N=897) and the general Victorian population (N=34,168) living in the state of Victoria in Australia. Proxy respondents were interviewed on behalf of people with ID, while respondents from the general Victorian population were interviewed directly. The data were weighted to reflect the age/sex/geographic distribution of the population. Results revealed that adults with ID reported higher prevalence of poor social determinants of health, behavioural risk factors, depression, diabetes, poor or fair health. A higher proportion of people with ID reported blood pressure and blood glucose checks, while a lower proportion reported cervical and breast cancer screening, compared with the general Victorian population. The survey identified areas where targeted approaches may be undertaken to improve the health outcomes of people with ID and provide an important understanding of the health and wellbeing of these Victorians.
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Affiliation(s)
- Syed Imran Haider
- Health Intelligence Unit, Victorian Government Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000, Australia.
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8
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Wu H, Deng L, Zhao L, Zhao J, Li L, Chen J. Osteoporosis associated with antipsychotic treatment in schizophrenia. Int J Endocrinol 2013; 2013:167138. [PMID: 23690768 PMCID: PMC3652172 DOI: 10.1155/2013/167138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/20/2013] [Accepted: 03/18/2013] [Indexed: 12/21/2022] Open
Abstract
Schizophrenia is one of the most common global mental diseases, with prevalence of 1%. Patients with schizophrenia are predisposed to diabetes, coronary heart disease, hypertension, and osteoporosis, than the normal. In comparison with the metabolic syndrome, for instance, there are little reports about osteoporosis which occurs secondary to antipsychotic-induced hyperprolactinaemia. There are extensive recent works of literature indicating that osteoporosis is associated with schizophrenia particularly in patients under psychotropic medication therapy. As osteoporotic fractures cause significantly increased morbidity and mortality, it is quite necessary to raise the awareness and understanding of the impact of antipsychotic-induced hyperprolactinaemia on physical health in schizophrenia. In this paper, we will review the relationship between schizophrenia, antipsychotic medication, hyperprolactinaemia, and osteoporosis.
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Affiliation(s)
- Haishan Wu
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Lu Deng
- Department of Nursing, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Lipin Zhao
- Department of Nursing, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jingping Zhao
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Lehua Li
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Jindong Chen
- Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha 410011, China
- *Jindong Chen:
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Letavernier E, Rodenas A, Guerrot D, Haymann JP. Williams-Beuren syndrome hypercalcemia: is TRPC3 a novel mediator in calcium homeostasis? Pediatrics 2012; 129:e1626-30. [PMID: 22566418 DOI: 10.1542/peds.2011-2507] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Williams-Beuren syndrome (WBS) is a neurodevelopmental disorder associated with hypercalcemia of unknown origin. This syndrome results from the deletion of contiguous genes on chromosome 7, including the general transcription factor IIi gene. The general transcription factor IIi gene encodes TFII-I, which suppresses cell-surface accumulation of transient receptor potential C3 (TRPC3) channels, involved in calcium transport in lymphocytes. We describe the case of a patient with WBS with hypercalcemia associated with abnormal TRPC3 expression. Analysis of peripheral lymphocytes revealed a sharp increase in TRPC3 expression, compared with control patients. To investigate the potential role of TRPC3 in calcium homeostasis, we performed specific immunostaining on the intestine and the kidney, major calcium-regulating tissues. We provide the first demonstration that TRPC3 is expressed in normal digestive epithelium and renal tubules in control patients, and overexpressed in the intestine in the patient with WBS. Taken together, these data suggest that calcium metabolism abnormalities observed in WBS may be attributable to TFII-I haploinsufficiency and subsequent TRPC3 overexpression, thereby increasing both digestive and renal calcium absorption. This original observation prompts further investigation of TRPC3 as a novel actor of calcium homeostasis.
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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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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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Torr J, Strydom A, Patti P, Jokinen N. Aging in Down Syndrome: Morbidity and Mortality. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2010. [DOI: 10.1111/j.1741-1130.2010.00249.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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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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Ryder KM, Tanner SB, Carbone L, Williams JE, Taylor HM, Bush A, Pintea V, Watsky MA. Teriparatide is safe and effectively increases bone biomarkers in institutionalized individuals with osteoporosis. J Bone Miner Metab 2010; 28:233-9. [PMID: 19806302 DOI: 10.1007/s00774-009-0123-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
Abstract
Institutionalized adults with severe developmental disabilities have a high rate of minimal trauma and appendicular fracture. There is little information about osteoporosis treatment in this population. In this efficacy and safety study, men and women with severe developmental disabilities and osteoporosis received 20 mcg teriparatide subcutaneously daily for 18-24 months. Markers of bone formation [procollagen type 1 intact N-terminal propeptide (P1NP)] and resorption [C-telopeptide (CTx)] were measured at three-month intervals. Serum calcium was measured at two-week intervals for 12 weeks and thereafter at three-month intervals. Twenty-seven individuals received at least one injection. The incidence of hypercalcemia was 11.1% but was persistent and led to medication discontinuation in only one participant. Biomarkers of bone formation increased rapidly, doubling by three months. At 12 months, P1NP and CTx remained elevated from baseline; P1NP had risen from 66.95 +/- 83.71 microg/l (mean +/- SD) to 142.42 +/- 113.85 microg/l (P = 0.05), and CTx had increased from 0.377 +/- 0.253 to 1.016 +/- 1.048 ng/ml (P = 0.01). The majority of participants had an increase in P1NP of over 10 microg/l. In conclusion, teriparatide is safe and effective in developmentally disabled institutionalized adults. Serial calcium measurements are warranted, particularly during the first three months of therapy.
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Affiliation(s)
- Kathryn M Ryder
- Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.
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Affiliation(s)
- Barbara R Pober
- Center for Human Genetics, Massachusetts General Hospital, Boston, MA 02114, USA.
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Stubbs B. Antipsychotic-induced hyperprolactinaemia in patients with schizophrenia: considerations in relation to bone mineral density. J Psychiatr Ment Health Nurs 2009; 16:838-42. [PMID: 19824978 DOI: 10.1111/j.1365-2850.2009.01472.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Schizophrenia affects about 1% of the world's population. Those with schizophrenia are at elevated risk of a variety of physical health conditions, including diabetes, coronary heart disease, hypertension and osteoporosis. Osteoporosis secondary to antipsychotic-induced hyperprolactinaemia (i.e. raised prolactin levels) has received little attention, when compared with reports on metabolic syndrome for instance. A recent study established that schizophrenia and prolactin-raising antipsychotic medication is directly associated with hip fractures. This is important and concerning as osteoporotic fractures are associated with much morbidity and mortality. This paper reviews the literature on antipsychotic-induced hyperprolactinaemia and its subsequent effects on bone mineral density.
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Cleaver S, Ouellette-Kuntz H, Hunter D. The Prevalence and Severity of Physical Mobility Limitations in Older Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2009. [DOI: 10.1111/j.1468-3148.2009.00499.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hawli Y, Nasrallah M, El-Hajj Fuleihan G. Endocrine and musculoskeletal abnormalities in patients with Down syndrome. Nat Rev Endocrinol 2009; 5:327-34. [PMID: 19421241 DOI: 10.1038/nrendo.2009.80] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Down syndrome has a prevalence of one in 500 to one in 1,000 live births and is the most common cause of mental retardation. Most patients are treated in childhood and adolescence for mental or growth retardation. Studies that evaluate bone mass in Down syndrome are limited, and many are small case series in pediatric and adult populations who live either in the community or in residential institutions. Several environmental and hormonal factors contribute to low bone mineral density in such patients. Muscle hypotonia, low amounts of physical activity, poor calcium and vitamin D intakes, hypogonadism, growth retardation and thyroid dysfunction contribute to substantial impairments in skeletal maturation and bone-mass accrual that predispose these patients to fragility fractures. Here, we review indications and limitations of bone-mass measurements in children, summarize the endocrine and skeletal abnormalities in patients presenting with Down syndrome, and review studies that investigate therapeutic strategies for such patients.
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Affiliation(s)
- Yousra Hawli
- Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
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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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Cleaver S, Hunter D, Ouellette-Kuntz H. Physical mobility limitations in adults with intellectual disabilities: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:93-105. [PMID: 19067784 DOI: 10.1111/j.1365-2788.2008.01137.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Mobility limitations increase with age in the general population. Despite a growing population of older adults with intellectual disabilities (ID), mobility is rarely studied in the ID literature. The specific aim of this study was to identify and summarise primary literature investigating mobility limitations in adults with ID. METHODS This study was a systematic review of the epidemiological literature (incidence and prevalence) of mobility limitations among adults with ID. Four electronic databases were searched from January 1980 to May 2007 for publications according to predefined inclusion/exclusion criteria. Additional sources were consulted. Two reviewers extracted data from each of the included articles. RESULTS Thirty-two publications representing 31 studies were ultimately included. In general, studies did not focus on mobility but were conducted for other purposes. All studies were conducted in industrialised countries. Only one study used a longitudinal design; the remainders were cross-sectional. Few investigators reported on the representativeness of the sample or the validity of the measurement tool. Study samples differed substantially and investigators used numerous definitions of mobility limiting comparability between studies. CONCLUSIONS There is a need for increased research on mobility limitations among adults with ID, particularly longitudinal research. Researchers investigating mobility limitations should use validated measurement tools and offer detailed descriptions of the study sample and how it compares with an identifiable population.
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Affiliation(s)
- S Cleaver
- Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Cleaver S, Ouellette-Kuntz H, Hunter D. Relationship Between Mobility Limitations and the Places Where Older Adults With Intellectual Disabilities Live. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2008. [DOI: 10.1111/j.1741-1130.2008.00186.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Women with intellectual disabilities (ID) need thoughtful, well-coordinated care from primary care physicians. They are particularly susceptible to experiencing disparities in care because of varied participation in shared decision making. This review of the current literature comments on the quantity and quality of existing studies regarding several key women's health issues: menstrual disorders, cervical and breast cancer screening, contraception, and osteoporosis. A review of the current thinking regarding ethical and legal issues in medical decision making for these women is also provided. We found that there are several high-quality studies recommending early and frequent screening for osteoporosis, which is more common in women with ID. Smaller and fewer studies comment specifically on techniques for accomplishing the gynecological examination in women with ID, although the cervical cancer screening recommendation should be individualized for these patients. Consensus data on the management of menstrual problems and contraception in women with ID is provided. There are some data on breast cancer incidence but few articles on methods to improve screening rates in women with ID.
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Affiliation(s)
- Joanne E Wilkinson
- Department of Family Medicine, Boston University School of Medicine, Massachusettes, USA.
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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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Guijarro M, Valero C, Paule B, Gonzalez-Macias J, Riancho JA. Bone mass in young adults with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:182-189. [PMID: 18261017 DOI: 10.1111/j.1365-2788.2007.00992.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Down syndrome (DS) is a frequent cause of intellectual disability. With the increasing life expectancy of these patients, concerns have been raised about the risk of osteoporosis. In fact, several investigators have reported a reduced bone mass in DS. However, the results may be confounded by comorbid diseases, and differences in lifestyle habits and body size. Therefore, we planned to determine anthropometric and lifestyle factors influencing bone mineral density (BMD) in young adults with DS. METHODS Thirty-nine patients with DS (mean age 26 years) and 78 controls were studied. Areal BMD was measured by dual x-ray densitometry (DXA); volumetric BMD at the lumbar spine and femoral neck was estimated with published formulae. RESULTS DS patients had lower areal BMD than controls at all regions (spine, hip and total body). Height and projected bone area were also lower. There were no differences between both groups regarding estimated volumetric BMD at the femoral neck. However, spine volumetric BMD was also lower in DS than controls. In multivariate analysis, DS, male sex, little physical activity and low sunlight exposure were associated with lower spine volumetric BMD; on the other hand, fat mass and sunlight exposure were associated with femoral neck volumetric BMD. CONCLUSION This study shows that patients with DS had a reduced areal BMD, but it is in part a consequence of the reduced body size, particularly at the femoral neck. Physical activity and sunlight exposure are associated to volumetric BMD and should be stimulated in order to maintain an adequate bone mass in these patients.
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Affiliation(s)
- M Guijarro
- Department of Internal Medicine, Hospital U.M. Valdecilla, University of Cantabria, Santander, Spain
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Supporting Safe Transitions From Home to Healthcare Settings for Individuals With Intellectual Disabilities. TOPICS IN GERIATRIC REHABILITATION 2008. [DOI: 10.1097/01.tgr.0000311408.47296.6c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The number of people over the age of 60 years with lifelong developmental delays is predicted to double by 2030. Down syndrome (DS) is the most frequent chromosomal cause of developmental delays. As the life expectancy of people with DS increases, changes in body function and structure secondary to aging have the potential to lead to activity limitations and participation restrictions for this population. The purpose of this update is to: (1) provide an overview of the common body function and structure changes that occur in adults with DS as they age (thyroid dysfunction, cardiovascular disorders, obesity, musculoskeletal disorders, Alzheimer disease, depression) and (2) apply current research on exercise to the prevention of activity limitations and participation restrictions. As individuals with DS age, a shift in emphasis from disability prevention to the prevention of conditions that lead to activity and participation limitations must occur. Exercise programs appear to have potential to positively affect the overall health of adults with DS, thereby increasing the quality of life and years of healthy life for these individuals.
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Affiliation(s)
- Robert C Barnhart
- Department of Physical Therapy, East Tennessee State University, Box 70624, Johnson City, TN 37614, USA.
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Abstract
Adults with intellectual disabilities need thoughtful, well-coordinated primary care from family physicians. However, evidence-based screening recommendations are lacking. We examined screening recommendations for common preventable conditions using the US Preventative Service Task Force guidelines. We also reviewed the literature about the prevalence of these conditions in adults with intellectual disabilities. Obesity, osteoporosis, and smoking are more prevalent in adults with intellectual disabilities, and enhanced screening for these conditions is recommended. Abnormal Papanicolaou smears and cervical cancer are less common in adults with intellectual disabilities and screening recommendations should be individualized. We also discussed strategies to make screening procedures less stressful for these patients.
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Affiliation(s)
- Joanne E Wilkinson
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Schrager S, Kloss C, Ju AW. Prevalence of fractures in women with intellectual disabilities: a chart review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2007; 51:253-9. [PMID: 17326806 DOI: 10.1111/j.1365-2788.2006.00872.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Numerous studies have demonstrated high rates of osteoporosis and fractures in women with intellectual disabilities (IDs). All of the studies use either institutionalized women or women in the community recruited at adult day-care centres or specialty clinics. We examined the prevalence of fractures in women with IDs who attend a primary care clinic, and assessed osteoporosis-prevention/intervention activities. METHODS This was a chart review study. Charts were identified of women with an ICD-9 diagnosis code for ID, Down syndrome or developmental disabilities. All charts reviewed were patients of one of 13 family medicine clinics affiliated with Department of Family Medicine, the University of Wisconsin. RESULTS A total of 93 charts were reviewed. More than 32% (30/93) of the charts contained a history of an adult-onset fracture. Increasing age, being postmenopausal and taking anticonvulsant medications were significantly associated with having a fracture. The average age of first fracture was 41.7 years. Of the women with a fracture, 35.5% were placed on a medication to maintain bone density, 67.7% received a recommendation for a calcium supplement, and 38.7% obtained a bone density test. DISCUSSION The prevalence of fractures in women with IDs attending a family medicine clinic was very high, and fractures occurred at young ages. Primary care providers need to consider women with IDs at a high risk for fractures and begin preventive counselling in young women.
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Affiliation(s)
- S Schrager
- Department of Family Medicine, University of Wisconsin, Madison, Wisconsin, USA.
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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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Keinan D, Smith P, Zilberman U. Microstructure and chemical composition of primary teeth in children with Down syndrome and cerebral palsy. Arch Oral Biol 2006; 51:836-43. [PMID: 16756941 DOI: 10.1016/j.archoralbio.2006.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 04/09/2006] [Accepted: 04/12/2006] [Indexed: 10/24/2022]
Abstract
This study was designed to test the hypothesis that prenatal growth insults leave permanent signs in the developing primary teeth that can be identified in later life. To test this hypothesis we examined exfoliated and extracted lower second primary molars of children with Down syndrome (DS) and cerebral palsy (CP). Teeth of children with no adverse medical history were used as a control group. Informed consent of parents and children was obtained in all cases. On each tooth two thin sections were cut, one bisecting the mesial cusps and one bisecting the distal cusps. Using a light microscope, the width of prenatal enamel and postnatal enamel was measured on each section at standardized locations from the dentin-enamel junction (DEJ) with the neonatal line used to distinguish between prenatal and postnatal enamel. Chemical analysis of each section was carried out using an energy dispersive spectrophotometer (ESR). The Ca/P ratios of enamel and dentin for each cusp were calculated and intercusp and intergroup differences analysed using non-parametric statistical tests. The results showed that significantly less enamel was laid down prenatally in DS and CP teeth than in the control group and that the enamel of the mesial cusps in these groups was less highly mineralised than that of the controls. The results also showed that in DS teeth growth and mineralisation of all cusps was affected. Based on these findings we propose that analysis of exfoliated deciduous teeth in developmentally challenged children may help in identifying the onset and severity of growth insults in utero and its impact on later development.
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Affiliation(s)
- David Keinan
- Laboratory of Bioanthropology and Ancient DNA, Hadassah School of Dental Medicine, Hebrew University, POB 12272, Jerusalem 91120, Israel
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Schmidt EV, Byars JR, Flamuth DH, Schott JJ, Sever CM. Prevalence of low bone-mineral density among mentally retarded and developmentally disabled residents in intermediate care. ACTA ACUST UNITED AC 2006; 19:45-51. [PMID: 16553466 DOI: 10.4140/tcp.n.2004.45] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the prevalence of low bone-mineral density (BMD) and related fractures among mentally retarded and developmentally disabled residents in intermediate care settings. DESIGN Cross-sectional study. SETTING Intermediate care facilities for mentally retarded and developmentally disabled (< 16 beds) and group homes (> or = 16 beds) in the mid-western United States. PARTICIPANTS A total of 360 residents were selected for the initial study group; 119 were excluded, 241 remained to study completion. INTERVENTION Antiresorptive therapy with alendronate 10 mg daily and calcium 500 mg with vitamin D 200 IU, three times daily, for participants in the osteoporosis range; calcium 500 mg with vitamin D 200 IU three times daily for participants in the osteopenia range. MAIN OUTCOME MEASURES Low BMD and related fractures. Secondary measures included medications associated with bone loss, mobility level, medical diagnoses associated with bone loss, diagnosis of bone disorders, level of mental retardation, pharmacotherapy and calcium supplementation, and demographic characteristics. RESULTS The prevalence of low BMD in this study group was 78.8% (n=189), with 157 (65.1%) participants in the osteoporosis range and 32 (13.3%) in the osteopenia range. The average age was 45.8 years, with residents ranging from 20 to 91 years; 67.6% (n=163) were male. Nearly three-fourths of participants were in either the severe or profound range of mental retardation. Forty residents received multiple medications, contributing to bone loss. The incidence of documented nontraumatic fractures was 3.5%. CONCLUSIONS Low BMD is prevalent in mentally retarded and developmentally disabled residents in intermediate care settings with low mobility and other risk factors. Consultant pharmacists have the opportunity to suggest appropriate pharmacotherapy for the treatment of low BMD in this setting.
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Zubillaga P, Garrido A, Mugica I, Ansa J, Zabalza R, Emparanza JI. Effect of vitamin D and calcium supplementation on bone turnover in institutionalized adults with Down's Syndrome. Eur J Clin Nutr 2005; 60:605-9. [PMID: 16391575 DOI: 10.1038/sj.ejcn.1602357] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the status of vitamin D and the effects of calcium and vitamin D3 supplementation on the bone metabolism in a group of adults with Down's syndrome (DS). DESIGN Randomized, parallel, controlled and open clinical trial. SETTING Institution for mentally handicapped: Fundación Uliazpi, Diputación Foral de Guipúzcoa, San Sebastián, Spain. SUBJECTS A total of 23 persons with DS, residents at the Uliazpi Foundation were recruited and all completed the study. INTERVENTION In all, 12 participants were randomly allocated to receive 1 g of calcium and 800 IU of vitamin D once daily for 1 year while 11 were assigned to the control group, receiving no supplementation. RESULTS We found no differences between groups regarding serum calcium and phosphorous levels. The remaining parameters showed differences between the two groups consistent with a beneficial effect of the intervention: serum levels of parathyroid hormone, osteocalcin and crosslaps diminished while serum 25 OH vitamin D3 level increased. CONCLUSIONS The results obtained allow to include people with DS as a risk group with regards to vitamin D deficit, which that can be corrected with vitamin D and calcium supplementation, and giving rise to an improvement of the biochemical markers related to the phospho-calcium metabolism and bone remodelling.
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Affiliation(s)
- P Zubillaga
- Fundacion Uliazpi, Portu-Etxe 53, 20018 San Sebastián, Gipuzkoa, Spain.
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Tyler C, Edman JC. Down syndrome, Turner syndrome, and Klinefelter syndrome: primary care throughout the life span. Prim Care 2004; 31:627-48, x-xi. [PMID: 15331252 DOI: 10.1016/j.pop.2004.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Down syndrome, Turner syndrome, and Klinefelter syndrome constitute the most common chromosomal abnormalities encountered by primary care physicians. Down syndrome typically is recognized at birth, Turner syndrome often is not recognized until adolescence,and many men with Klinefelter syndrome are never diagnosed. Although each syndrome is caused by an abnormal number of chromosomes, or aneuploidy, they are distinct syndromes with learning disabilities and a predisposition toward autoimmune diseases,endocrinologic disorders, and cancers. Optimal health care requires a thorough knowledge of the unique health risks, psychoeducational needs, functional capabilities, and phenotypic variation associated with each condition. Syndrome-specific health care should complement standard preventive health care recommendations. Checklists and syndrome-specific growth grids should be used. Ongoing communication between specialists and primary care physicians and between pediatric and adult clinicians is essential. Support groups and Internet resources can benefit affected individuals and their families immensely.
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Affiliation(s)
- Carl Tyler
- Cleveland Clinic Foundation Family Practice/Fairview Hospital, 18200 Lorraine Avenue, Cleveland, OH 44111, USA.
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Abstract
Women with physical and cognitive disabilities are at high risk for osteoporosis and osteoporosis-related fractures. Women with physical disabilities frequently are nonambulatory and have bone loss due to immobility. Women with cognitive disabilities have high rates of osteopenia and osteoporosis, likely partially due to high rates of anticonvulsant medication use. Women with Down syndrome are at especially high risk of osteopenia and osteoporosis, possibly because of lower peak bone density levels. Prevention of osteoporosis and related fractures in this population includes population-based measures, such as calcium and vitamin D supplementation and risk-based screening procedures. Primary care providers and specialists need to prioritize osteoporosis prevention strategies when taking care of women with disabilities. Future research is needed to determine optimal screening and prevention strategies in this very high risk population.
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Affiliation(s)
- Sarina Schrager
- Department of Family Medicine, University of Wisconsin, Madison, Wisconsin 53715, USA.
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Zilberman U, Patricia S, Kupietzky A, Mass E. The effect of hereditary disorders on tooth components: a radiographic morphometric study of two syndromes. Arch Oral Biol 2004; 49:621-9. [PMID: 15196980 DOI: 10.1016/j.archoralbio.2004.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare tooth components (enamel and dentin) in Familial Dysautonomia (FD) and Down syndrome (DS) in order to assess the extent to which each was affected. DESIGN The design was cross-sectional. The sample consisted of 20 FD patients and 45 DS patients. The control group comprised 250 healthy subjects. Mesio-distal crown width (CW), enamel and dentin thickness and pulp chamber dimensions were measured on standardized bitewing radiographs of mandibular second primary and first permanent molars. Statistical analyses were performed between groups using SAS programs. RESULTS CW was reduced in both hereditary disorders. In the DS group enamel height (EH) and dentin thickness were reduced. In FD enamel thickness in the primary and permanent molars as well as dentin height (DH) in permanent molars was increased. CONCLUSIONS In both syndromes the reduction in CW suggests reduced proliferation during tooth germ formation. However, the differences in enamel and dentin thickness suggest that ameloblasts and odontoblasts were affected differently in the later phases of cell function. In FD cell function is stimulated resulting in thicker enamel and dentin. In DS cell function is reduced resulting in thin enamel and dentin.
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Affiliation(s)
- Uri Zilberman
- Laboratory of Bioanthropology and Ancient DNA, Faculty of Dental Medicine, Hebrew University, Hadassah, Jerusalem, Israel.
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Curtis R, Freitag P, LaGuardia JJ, Thornton S, Vicari S, Markwell S. Spinal cord compromise: an important but underdiagnosed condition in people with mental retardation. Public Health Rep 2004; 119:396-400. [PMID: 15219796 PMCID: PMC1497652 DOI: 10.1016/j.phr.2004.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Rod Curtis
- Division of Developmental Disabilities, Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, 32702, USA
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Haveman MJ. Disease Epidemiology and Aging People with Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2004. [DOI: 10.1111/j.1741-1130.2004.04003.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cherniske EM, Carpenter TO, Klaiman C, Young E, Bregman J, Insogna K, Schultz RT, Pober BR. Multisystem study of 20 older adults with Williams syndrome. ACTA ACUST UNITED AC 2004; 131:255-64. [PMID: 15534874 DOI: 10.1002/ajmg.a.30400] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
To address the natural history of Williams syndrome (WS), we performed multisystem assessments on 20 adults with WS over 30 years of age and documented a high frequency of problems in multiple organ systems. The most striking and consistent findings were: abnormal body habitus; mild-moderate high frequency sensorineural hearing loss; cardiovascular disease and hypertension; gastrointestinal symptoms including diverticular disease; diabetes and abnormal glucose tolerance on standard oral glucose tolerance testing; subclinical hypothyroidism; decreased bone mineral density on DEXA scanning; and a high frequency of psychiatric symptoms, most notably anxiety, often requiring multimodal therapy. Review of brain MRI scans did not demonstrate consistent pathology. The adults in our cohort were not living independently and the vast majority were not competitively employed. Our preliminary findings raise concern about the occurrence of mild accelerated aging, which may additionally complicate the long-term natural history of older adults with WS. We provide monitoring guidelines to assist in the comprehensive care of adults with WS.
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Lustig JP, Yanko R, Zilberman U. Use of dental implants in patients with Down syndrome: a case report. SPECIAL CARE IN DENTISTRY 2002; 22:201-4. [PMID: 12580359 DOI: 10.1111/j.1754-4505.2002.tb00271.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Down syndrome is caused by trisomy of the 21st chromosome and is associated with well-described physical and systemic problems. Most people with Down syndrome have some degree of mental retardation as well as malformation of head and neck. Oral structures that are commonly affected include the tongue (macroglossia), abnormalities in the number and shape of teeth, and poor quality (osteoporotic-like) of alveolar bone and jaw. These oral malformations as well as a tendency toward poor cooperation in the dental office contribute to the belief among dentists that people with Down syndrome are not good candidates for oral rehabilitation with dental implants. This article describes the use of dental implants in the oral rehabilitation of a 16-year-old boy with Down syndrome. Although more experience is needed before dental implants can be considered a suitable option during oral rehabilitation in people with Down syndrome, this case report shows a promising beginning.
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Affiliation(s)
- Joseph P Lustig
- Dental Clinic for Medically Compromised Patients, Barzilai Medical Center, Ashkelon, Israel
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Karjalainen S, Vanhamäki M, Kanto D, Kössi L, Sewón L, Salo M. Long-term physical inactivity and oral health in Finnish adults with intellectual disability. Acta Odontol Scand 2002; 60:50-5. [PMID: 11902613 DOI: 10.1080/000163502753472005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Physical inactivity is prevalent among patients with intellectual disability. Because little is known about the oral effects of poor mobility, we reviewed the medical and dental charts of institutionalized dentate patients (n = 214; 40.2 years +/- 12.1) of the Special Welfare District of Southwestern Finland. The number of decayed, missing, and filled teeth (DMFT), the number of retained teeth, dental treatment visits, and the type of the first treatment visit were recorded. Physical activity was good in 55% and severely reduced or completely absent in 45% of the patients. The degree of intellectual disability was mild or moderate in 40% and severe or profound in 60% of the patients. The walking patients weighed more (64.3 (19.6) versus 44.4 (14.4) kg; P< 0.001), had fewer secondary diagnoses (1.4 (1.3) versus 2.2 (1.4); P< 0.001), fewer daily medications (4.0 (2.1) versus 4.8 (2.4); P< 0.02), higher DMFT scores (18.5 (8.2) versus 14.8 (9.2); P < 0.05), and more dental treatment visits (2.7 (2.4) versus 2.0 (1.3); P< 0.03) than patients with poor physical activity. Periodontal treatment given as the primary type of dental care was more common among subjects with poor mobility than among those with good motor activity (P < 0.002). Poor physical activity was related to better dental health, higher need for periodontal therapy, and fewer dental visits than in patients with good motor activity.
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Affiliation(s)
- Sára Karjalainen
- Institute of Dentistry and Department of Anesthesiology and Intensive Care, University of Turku, Finland.
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