NCPAD:Your Writes: Focus on Secondary Condition Prevention: Osteoporosis Risk and Low Bone Mineral Density in People with Developmental Disabilities

Osteoporosis Risk and Low Bone Mineral Density in People with Developmental Disabilities

Dr. Jennifer Rowland

The following is Part III of a series of columns on the topic of osteoporosis in people with disabilities. This month’s column is focusing on people with developmental disabilities.

Over the past decade, research assessing the prevalence of low bone mineral density for people with developmental disabilities has provided evidence that this population is at high risk for osteoporosis (Aspray et al., 1998; Center, Beange, & McElduff, 1998;Jaffe,Timell, & Gulanski, 2001; Jaffe & Timell, 2003; Kao, Chen, Wang, & Yeh, 1992; Sepulveda et al., 1995). This past weekend in a congressional hearing preceding the Special Olympics in Ames, Iowa, CDC Director Julie Gerberding and former Surgeon General Antonia Novello underscored health disparities for people with developmental disabilities, one of which was osteoporosis, thereby acknowledging it is an important health issue to address in this population.

Risk factors that place people with developmental disabilities at high risk for osteoporosis include: (a) small physical frame; (b) hypotonia; (c) reduced mobility; (d) vitamin D deficiency associated with anticonvulsant medication; and (e) frequent falls (Jaffe et al., 2001). Another risk factor that has not received much research attention is the onset of menopause in older women with developmental disabilities (http://www.thearc.org/faqs/whealth.html). Some research has provided evidence that women with Down syndrome may experience menopause at an earlier age than the general population, which means less estrogen is produced. Because estrogen is a factor in maintaining bone density, once this drop in production occurs, the individual becomes at greater risk for osteoporosis.

Research by Jaffe et al. (2001) examining bone mineral density for an institutionalized population of postmenopausal women with developmental disabilities found that a bone density measure of the calcaneus (heel) indicated there was a much higher degree of bone loss in this population than a group of age-matched controls. A more recent study by Jaffe and Timell (2003) examined bone mineral density in a group of institutionalized men with developmental disabilities and found that this group also had a significantly lower bone mineral density than a control population. This evidence indicates that both genders are at risk for osteoporosis and should be directed toward prevention interventions.

Here are a few osteoporosis prevention recommendations:

Exercise: weightbearing activities such as walking, running, or standing exercise programs are important parts of a prevention program. Exercise can also help to keep the individual at a healthy weight which can improve activity and function.

Quit Smoking: cigarette smoking decreases the body’s ability to process calcium, and there is evidence that smokers have twice the risk of having a hip fracture than non-smokers.

Medication Effects: little research has been performed on the effect of Hormone Replacement Therapy (HRT) for women with developmental disabilities. Literature for women without disabilities provides evidence that there has been benefit in reducing osteoporosis using HRT. However, there are many associated health risks associated with HRT, and must be discussed with each individual’s physician.

Further information about osteoporosis prevention for adults aging with developmental disabilities can be found at http://www.thearc.org/faqs/whealth.html that include recommendations from the Rehabilitation Research and Training Center on Aging with Developmental Disabilities at the University of Illinois at Chicago, and The Arc of Monmouth County, Tinton Falls, New Jersey.

Continuing next month, this series of osteoporosis columns will provide information on osteoporosis risk for people with other types of physical and cognitive disabilities in addition to prevention recommendations, examination of intervention research focusing on prevention and treatment efforts, and an overview of medical treatment options.

Questions from Column Readers

Several readers have asked about the effect of Fosamax, one of a new generation of bisphosphonates that is a treatment for people with metastatic bone disease, osteoporosis, and Paget’s disease. Note that this column does not provide information that is a substitute for seeking medical advice from your personal physician, and you should consult your doctor to determine specific medical advice that is applicable to you. A recent article published in Laryngoscope (Farrugia et al., 2006) reviewed a series of people who were diagnosed with osteonecrosis (death of bone) of the mandible or maxilla (jaw bone) and all who were being treated with new generation biophosphates, one of which is Fosamax (alendronate). According to these authors, this effect is a newly described entity and future research is needed to identify epidemiologic risk factors and the pathophysiology of osteonecrosis associated with this medication. Currently, there is no known effective treatment for this drug-induced osteonecrosis (Farrugia et al., 2006; p. 119). Because little is known about the reasons for this effect in some people, the current literature on this topic is still emerging..

Note that this column does not provide information that is a substitute for seeking medical advice from your personal physician, and you should consult your doctor to determine specific medical advice that is applicable to you.

I encourage you to write to me with suggestions for future column topics or to comment on the information provided in this column. You can reach me, Dr. Jennifer Rowland, by e-mail at jenrow@uic.edu or (312) 413-1850.

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This fact sheet was last updated on 07-10-2006.