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Fracture rates are substantially higher in those with intellectual disability

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The lack of recognition of people with intellectual disability (ID) as being at increased risk of fracture in the current osteoporosis guidelines may result in missed chances for prevention. A new study led by researchers at the University of Oxford and Oxford Health NHS Foundation Trust assesses the incidence of fractures in people with ID over the life course. These could include impaired bone mass due to limitations in mobility and a sedentary lifestyle, a tendency to fall, and accompanying medical conditions.

Researchers looked at rates of fracture recorded either in general practice or in hospital records over 20 years, 1998-2017. They compared rates throughout a person’s life between 43,000 people with intellectual disability (also known as a learning disability) and 215,000 without.

They found that fracture rates are substantially higher in those with intellectual disabilities. Fracture incidence starts to rise as people get older, but in those with an intellectual disability, the rise begins many years earlier than expected.

The most often fractured bone types indicate that osteoporosis with early onset is the cause of the elevated rates. The frequency of hip fractures is particularly high. Hip fracture rates are comparable in those with intellectual disabilities, but they happen 15 to 25 years earlier.

For instance, the hip fracture rate in women with intellectual disabilities at age 45 is comparable to that of women without intellectual disabilities at age 60. Hip fracture rates among 45-year-old men with intellectual disabilities and 70-year-old men without intellectual disabilities are comparable.

Margaret Smith, Senior Statistician and Epidemiologist from the Nuffield Department of Primary Care Health Sciences, explains further:

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“We estimated that in 10,000 women over 50 years old with intellectual disability, 53 would be expected to develop a hip fracture over one year compared to 23 in the general population. For men over 50 years old, these numbers are 38 and 10 respectively.”

Lead author Valeria Fright, Senior Clinical Research Fellow at the Department of Psychiatry, said:

“The study has identified an important and currently unmet health need in the population with intellectual disabilities. GPs should consider addressing the issue of bone health during the yearly statutory health check offered to people with intellectual disabilities.”

Journal Reference:

  1. Valeria Fright, Tim A. Holt et al. Incidence of fractures in people with intellectual disabilities over the life course: a retrospective matched cohort study. eClinical Medicine. DOI: 10.1016/j.eclinm.2022.101656

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