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Dr. Eilish Burke Ussher Assistant Professor in Ageing and Intellectual Disability RGN RNID BNS MSc PhD An exploration of the bone health of older adults with an intellectual disability
Dr. Eilish Burke Ussher Assistant Professor in Ageing and Intellectual Disability
RGN RNID BNS MSc PhD
An exploration of the bone health of older adults with an intellectual disability
Trinity College Dublin, The University of Dublin
What I set out to do…..
Investigate the prevalence of osteopenia and osteoporosis among people with intellectual disability (ID)
Develop an assessment process to ensure all people with ID could be included in objective health measures
Identify modifiable and non modifiable predictors for the presence of poor bone health
Trinity College Dublin, The University of Dublin
What is osteoporosis?
Insidious nature - No early warning signs
Results in osteoporosis being underreported and under treated.
In the over-60s age group in Ireland, the mortality as a direct consequence of hip fracture is 20% within 6
to 12 months
Est. 300,000 people in Ireland have osteoporosis.
1 in 5 men and 1 in 3 women will develop a fracture due to osteoporosis
Irish Osteoporosis Society
Why explore bone health
Trinity College Dublin, The University of Dublin
Increased risk loading
for poor bone health
in PWID
Level of ID
Living circumstance
Communication challenges
Phenotype specific
Specific prevalent conditions –
epilepsy & assoc. medications
Trinity College Dublin, The University of Dublin
Wave 1: (N=753) Examining doctor’s diagnosis
• All participants provided Dr’s diagnosis – from their medical files
• 8.1% (n=61/753) reported Dr’s diagnosis of osteoporosis in Wave 1
• 20.6% (n=152/753) history of previous fracture 12.6% reported hip fracture – over 3 times greater than hip fracture rates from TILDA
Trinity College Dublin, The University of Dublin
Risk factors
Non-modifiable
Multimorbidity – 71% (2 or more conditions)
Specific health condition that impact on bone health
• Epilepsy – 31.1% (n=287) – 38% AEDs
• Mental Health 47.5% (n=355)- antipsychotic medications 43.8% (n=328)
Down syndrome – 20% (n=147)
57% menopause – mean age 47yrs
Modifiable
• 61% overweight
• Physical activity levels low – 84% did not engage in vigorous PA
• 38% reported rarely or never drinking milk
• 26.7% reported a fall in the last year with 14% reporting 2+ falls
Burke, EA., Carroll, R, McCallion, P. Walsh, JB. and McCarron (2016) An exploration of the bone health of older adults with an intellectual disability in Ireland. Journal of Intellectual Disability Research DOI: 10.1111/jir.12273
Trinity College Dublin, The University of Dublin
Yet…
• Just 11% reported having a DXA in the last 2 years
• 86% of the females did not have a DXA in the last 2 years
• 3 in 10 participants who had a doctor’s diagnosis were not taking either Vitamin D or calcium supplementation
• Almost 2/3 of those with a history of fracture were also not taking either or a combination of these preventative measures
Trinity College Dublin, The University of Dublin
Setting up the Health Fair
Wave 1 success
Comparable to TILDA measures
Inclusion of a suite of 8 objective measures to enhance the focus on successful active ageing
Avoid labelling as a test – Health Fair
Trinity College Dublin, The University of Dublin
Objective measurements
Grip Strength Timed Up and
Go Blood Pressure
Waist and Hip
Circumference
Height and Weight
Measurements
Quantitative Ultrasound
(QUS)
The challenge of measuring bone quality in people with ID
OS CALCIS - calcaneus bone
Trinity College Dublin, The University of Dublin
Contribution to Success
Emancipatory Philosophy
Trinity College Dublin, The University of Dublin
Wave 2: QUS (N=575)
•Reported Dr’s diagnosis of osteoporosis
•QUS OM
41% (n=236/575) QUS objective evidence of osteoporosis
33.2% (n=191/575) QUS objective evidence of
osteopenia
14.4% (n=81/575)
18.5% SLDO
Trinity College Dublin, The University of Dublin
Of the men with objective evidence of osteoporosis
9 out of 10 did not have a doctor’s diagnosis
Of the women with objective evidence of osteoporosis almost 7 out of 10 did not
have a doctor’s diagnosis of osteoporosis.
Trinity College Dublin, The University of Dublin
Identified Risk Factors • Smoking and alcohol
consumption was negligible
• 0.9% corticosteroids
• 3.5% Identified parental history of fracture
• 74.7% menopause
• 41.6% AED medications
• 34% difficulty walking
• 49.2% below Ca intake recommendations
Trinity College Dublin, The University of Dublin
Overall 2/3 of participants were taking medicines that contributed to poor bone health
Men with ID were 12 times more likely to present
with objective evidence of osteoporosis than their peers in the general population TILDA
Over 1/5 of participants reported a history of fracture
Over 50% of the participants with Down syndrome had evidence of poor bone health
Trinity College Dublin, The University of Dublin
25.4% (n=142) reported having attended
for DXA
67% with history of fracture did NOT have a DXA
4.5% (n=26) reported receiving health
promotion education on bone health
Trinity College Dublin, The University of Dublin
Multinomial logistic model Risk factor Osteopenia Osteoporosis
P-value
AOR CI 95% P-
value AOR CI 95%
Difficulty walking 0.056 1.897 0.985 - 3.653 <0.001 6.175 3.273 - 11.65
Severe/profound ID 0.102 1.96 0.874 - 4.394 0.001 4.239 1.859 - 9.668
Residential living 0.04 2.204 1.038 - 0.061 0.061 2.197 0.964 - 5.01
Proton pump inhibitors 0.587 1.198 0.624 - 2.299 0.018 2.166 1.139 - 4.118
Down syndrome 0.001 0.349 0.189 - 0.644 <0.001 0.179 0.089 - 0.362
Trinity College Dublin, The University of Dublin
Chi-squared Automatic Interaction Detector Analysis (CHAID)
• Decision tree technique
• Logic ‘if then’
• Chooses the best partition on the basis of statistical significance
Kass 1980; Murphy & Comiskey 2013; Miller et al 2014
Trinity College Dublin, The University of Dublin
CHAID - Osteopenia
AEDs p-value=0.001
AEDs yes = 68.4%
osteopenia Cause of ID p=0.020
DS 37.3% osteopenia
SLDO DS
5.9%
Trinity College Dublin, The University of Dublin
CHAID Osteoporosis
Difficulty walking p<0.0001
AED p=0.004 PPI p=0.043
93.5%
87.2%
60%
45.1%
Trinity College Dublin, The University of Dublin
CHAID Osteopenia and osteoporosis
Difficulty walking p<0.0001
67.4%
Level of ID p=0.015
Severe to Profound level 80%
AEDs p=0.025
Mild moderate level with
AEDs 67%
Trinity College Dublin, The University of Dublin
MULTIDIMENSIONAL APPROACH
Screening Strategy
Increased education and awareness
Implementation of prevention strategies to include diet exercise &
supplementation
Risk observation and identification
Clinical Practice & Research Implications
Summary
DXA is the gold standard
Particular challenges for PWID
QUS was deemed acceptable with 85% from the HF engaging
Presents a worrying concern of poor bone quality in general of older adults with ID
Major implications for clinical practice and care
Trinity College Dublin, The University of Dublin
Acknowledgement
Grateful appreciation to the participants and families
Especially Ms. Lorraine Keating
Funders
