Vitamin D, bone mineral density and risk of fracture in people with intellectual disabilities

• Published in: Journal of intellectual disability research Vol. 63; no. 4; pp. 357 - 367
• Main Authors: Frighi, V., Morovat, A., Andrews, T. M., Rana, F., Stephenson, M. T., White, S. J., Fower, E., Roast, J., Goodwin, G. M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2019
• Subjects: Blood tests; Bone density; Bone mineral density; Deviation; Dietary supplements; fracture; Fractures; hypogonadism; impaired mobility; Intellectual disabilities; Intellectual Disability; Lifestyles; Mobility; Osteopenia; Osteoporosis; Risk assessment; Serum; Vitamin D; Vitamin deficiency; bone mineral density; intellectual disabilities; hypogonadism; impaired mobility; vitamin D; osteoporosis; fracture
• ISSN: 0964-2633; 1365-2788
• DOI: 10.1111/jir.12581

Background
People with intellectual disabilities (IDs) have very high rates of osteoporosis and fractures, to which their widespread vitamin D deficiency and other factors could contribute. We aimed to assess in people with IDs previously treated for vitamin D deficiency (1) long‐term adherence to vitamin D supplementation and (2) bone mineral density (BMD), as an indicator for risk of fractures, according to vitamin D supplementation and other factors.
Method
We recorded height, weight, medical, pharmacological, dietary and lifestyle assessment. Blood sample were taken for vitamin D and related analytes. dual‐energy X‐ray absorptiometry for BMD was performed.
Results
Of 51 study participants (mean [standard deviation, SD] age 51.5 [13.6] years, 57% male), 41 (80.4%) were taking vitamin D and 10 were not. Mean [SD] serum vitamin D was 81.3 [21.3] vs. 25.2 [10.2] nmol/L (P < 0.0001), respectively. Thirty‐six participants underwent a dual‐energy X‐ray absorptiometry scan, which showed osteoporosis in 23.7% and osteopenia in 52.6%. Participants on vitamin D had higher BMD than those who were not, a statistically significant difference when confounders (lack of mobility and hypogonadism) were removed. BMD was significantly different according to mobility, particularly in wheelchair users, in whom hip BMD was 33% lower (P < 0.0001) than in participants with normal mobility. Participants still taking vitamin D showed a 6.1% increase in BMD at the spine (P = 0.003) after mean [SD] 7.4 [1.5] years vitamin D treatment.
Conclusions
In people with IDs and previous vitamin D deficiency, BMD increases on long‐term vitamin D supplementation. However, additional strategies must be considered for osteoporosis and fracture prevention in this population.