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Fracture risk in people with developmental disabilities: results of a large claims data analysis

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Abstract

Summary

Age- and sex-specific fracture rates of 18,000 people with developmental disabilities aged 0–69 years were compared to the general population. Age-standardized incidence of femoral fracture was 4.8- and 7.1-fold higher in women and men, respectively. Comparable fracture risks to the general population occurred 10–15 years earlier in females and 20–40 years earlier in males.

Introduction

Previous studies suggested that fracture risks in people with developmental disabilities (DD) may be higher than in people in the general population. However, there are no current sufficiently large studies to compare age- and sex-specific fracture rates of single fracture types.

Methods

People with DD and incident fractures were identified by routine data of a health insurance company. Fractures in the general population were derived from the official fracture statistics. Age-specific and age-standardized fracture incidences were analyzed. To compare fracture risks in people with DD with that of the general population incidence ratios were calculated.

Results

Between 2008 and 2010, 148 femoral fractures and 469 other fractures were observed in nearly 18,000 people with DD aged 0–69 years. The three most frequent fracture types leading to hospital admission were fractures of the femur, lower leg/ankle, and shoulder/arm. For femoral fractures, a particularly high risk was observed in children and adolescents with DD. In adults with DD, the risk of femoral fractures increased with increasing age. Even if the youngest age category was not considered, the age-standardized incidence was 4.8- and 7.1-fold higher in women and men, respectively. For all other fracture types, except fractures of forearm/hand and of pelvis, people with DD had also higher fracture incidences than the general population.

Conclusions

People with DD have a high fracture burden. Comparable risks of femoral fracture, for example, occurred about 10–15 years earlier in females and even 20–40 years earlier in males with DD than in the general population.

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References

  1. Peel NM (2011) Epidemiology of falls in older age. Can J Aging Rev Can Vieil 30(1):7–19

    Article  Google Scholar 

  2. Dennison E, Mohamed MA, Cooper C (2006) Epidemiology of osteoporosis. Rheum Dis Clin N Am 32(4):617–29

    Article  Google Scholar 

  3. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet Lond Engl 359(9319):1761–7

    Article  Google Scholar 

  4. Srikanth R, Cassidy G, Joiner C, Teeluckdharry S (2011) 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. J Intellect Disabil Res JIDR 55(1):53–62

    Article  CAS  PubMed  Google Scholar 

  5. Schrager S (2004) Osteoporosis in women with disabilities. J Womens Health 2002 13(4):431–7

    Article  Google Scholar 

  6. Center J, Beange H, McElduff A (1998) People with mental retardation have an increased prevalence of osteoporosis: a population study. Am J Ment Retard AJMR 103(1):19–28

    Article  CAS  PubMed  Google Scholar 

  7. Hsieh K, Rimmer J, Heller T (2012) Prevalence of falls and risk factors in adults with intellectual disability. Am J Intellect Dev Disabil 117(6):442–54

    Article  PubMed  Google Scholar 

  8. Cox CR, Clemson L, Stancliffe RJ, Durvasula S, Sherrington C (2010) Incidence of and risk factors for falls among adults with an intellectual disability. J Intellect Disabil Res JIDR 54(12):1045–57

    Article  CAS  PubMed  Google Scholar 

  9. Schrager S (2006) Epidemiology of osteoporosis in women with cognitive impairment. Ment Retard 44(3):203–11

    Article  PubMed  Google Scholar 

  10. Grant H, Pickett W, Lam M, O’Connor M (2001) Falls Among Persons Who Have Developmental Disabilities in Institutional and Group Home Settings. J Develop Disabil 8(1):57–73

    Google Scholar 

  11. Finlayson J, Turner A, Granat MH (2011) Measuring the actual levels and patterns of physical activity/inactivity of adults with intellectual disabilities. J Appl Res Intellect Disabil 24(6):508–17

    Article  Google Scholar 

  12. Tannenbaum TN, Lipworth L, Baker S (1989) Risk of fractures in an intermediate care facility for persons with mental retardation. Am J Ment Retard AJMR 93(4):444–51

    CAS  PubMed  Google Scholar 

  13. Lohiya GS, Crinella FM, Tan-Figueroa L, Caires S, Lohiya S (1999) Fracture epidemiology and control in a developmental center. West J Med 170(4):203–9

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Glick NR, Fischer MH, Heisey DM, Leverson GE, Mann DC (2005) Epidemiology of fractures in people with severe and profound developmental disabilities. Osteoporos. Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 16(4):389–96

    Article  Google Scholar 

  15. Vanlint S, Nugent M (2006) Vitamin D and fractures in people with intellectual disability. J Intellect Disabil Res JIDR 50(Pt 10):761–7

    Article  CAS  PubMed  Google Scholar 

  16. Kawada T (2002) Factors influencing bone fractures in severely disabled persons. Am J Phys Med Rehabil Assoc Acad Physiatr 81(6):424–8

    Article  Google Scholar 

  17. Hoffmann F, Glaeske G (2006) [Incidence of hip fracture in Germany--person-related analysis of health insurance population]. Gesundheitswesen Bundesverb. Ärzte Öffentl. Gesundheitsdie nstes Ger 68(3):161–4

    CAS  Google Scholar 

  18. Wang D, McDermott S, Sease T (2002) Analysis of hospital use for injury among individuals with mental retardation. Inj Control Saf Promot 9(2):107–11

    Article  PubMed  Google Scholar 

  19. Finlayson J, Morrison J, Jackson A, Mantry D, Cooper S-A (2010) Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study. J Intellect Disabil Res JIDR 54(11):966–80

    Article  CAS  PubMed  Google Scholar 

  20. Wagemans AMA, Cluitmans JJM (2006) Falls and fractures: a major health risk for adults with intellectual disabilities in residential settings. J Policy Pract Intellect Disabil 3(2):136–8

    Article  Google Scholar 

  21. Schrager S, Kloss C, Ju AW (2007) Prevalence of fractures in women with intellectual disabilities: a chart review. J Intellect Disabil Res JIDR 51(Pt 4):253–9

    Article  CAS  PubMed  Google Scholar 

  22. Watson KC, Lentz MJ, Cain KC (2006) Associations between fracture incidence and use of depot medroxyprogesterone acetate and anti-epileptic drugs in women with developmental disabilities. Womens Health Issues Off. Publ. Jacobs Inst. Womens Health 16(6):346–52

    Google Scholar 

  23. Jancar J, Jancar MP (1998) Age-related fractures in people with intellectual disability and epilepsy. J Intellect Disabil Res JIDR 42(Pt 5):429–33

    PubMed  Google Scholar 

  24. Sherrard J, Tonge BJ, Ozanne-Smith J (2001) Injury in young people with intellectual disability: descriptive epidemiology. Inj Prev J Int Soc Child Adolesc Inj Prev 7(1):56–61

    Article  CAS  Google Scholar 

  25. Hsieh K, Heller T, Miller AB (2001) Risk factors for injuries and falls among adults with developmental disabilities. J Intellect Disabil Res JIDR 45(Pt 1):76–82

    Article  CAS  PubMed  Google Scholar 

  26. Smulders E, Enkelaar L, Weerdesteyn V, Geurts ACH, van Schrojenstein Lantman-de Valk H (2013) Falls in older persons with intellectual disabilities: fall rate, circumstances and consequences. J Intellect Disabil Res JIDR 57(12):1173–82

    CAS  PubMed  Google Scholar 

  27. Finlayson J, Jackson A, Cooper S-A, Morrison J, Melville C, Smiley E, Allan L, Mantry D (2009) Understanding predictors of low physical activity in adults with intellectual disabilities. J Appl Res Intellect Disabil 22(3):236–47

    Article  Google Scholar 

  28. Petty SJ, O’Brien TJ, Wark JD (2007) Anti-epileptic medication and bone health. Osteoporos Int 18(2):129–142

  29. Kommunalverband für Jugend und Soziales, Baden-Württemberg, Dezernat Soziales. Fallzahlen und Ausgaben in der Eingliederungshilfe nach dem SGB XII für 2010. Planungs- und Steuerungsunterstützung für die Stadt- und Landkreise in Baden-Württemberg [Internet]. 2011 [cited 2015 Oct 7]. Available from: http://www.kvjs.de/fileadmin/publikationen/soziales/EGH-Bericht-2010.pdf

  30. Bittles AH, Petterson BA, Sullivan SG, Hussain R, Glasson EJ, Montgomery PD (2002) The influence of intellectual disability on life expectancy. J Gerontol A Biol Sci Med Sci 57(7):M470–472

    Article  CAS  PubMed  Google Scholar 

  31. Fisher K, Kettl P (2005) Aging with mental retardation: increasing population of older adults with MR require health interventions and prevention strategies. Geriatrics 60(4):26–9

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany

    G. Büchele, D. Rothenbacher & K. Rapp

  2. Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany

    C. Becker & K. Rapp

  3. John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, St Leonards, NSW 2065, Australia

    I. D. Cameron

  4. Department of care management, AOK Baden-Württemberg, Presselstr. 19, 70191, Stuttgart, Germany

    R. Auer

  5. Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    H. H. König

Authors
  1. G. Büchele
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  2. C. Becker
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  3. I. D. Cameron
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  4. R. Auer
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  5. D. Rothenbacher
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  6. H. H. König
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  7. K. Rapp
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Corresponding author

Correspondence to G. Büchele.

Ethics declarations

The study was approved by the ethics committee of the University of Ulm.

Conflicts of interest

None.

Funding

The analysis was supported by the Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01EC1007A).

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Büchele, G., Becker, C., Cameron, I.D. et al. Fracture risk in people with developmental disabilities: results of a large claims data analysis. Osteoporos Int 28, 369–375 (2017). https://doi.org/10.1007/s00198-016-3733-1

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  • DOI: https://doi.org/10.1007/s00198-016-3733-1

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