Volume 183 - Issue 1
Vitamin D and adult bone health in Australia and New Zealand: a position statement
Author: Simon J Vanlint
Med J Aust 2005; 183 (1): 52-54. || doi: 10.5694/j.1326-5377.2005.tb06895.x
Published online: 20 June 2005
Published online: 20 June 2005
Simon J Vanlint
Lecturer, Department of General Practice, University of Adelaide, SA 5005. simon.vanlintATadelaide.edu.au
To the Editor: The Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia are to be commended for their clear and succinct position statement on vitamin D and bone health.1 This statement highlights an important public health issue which is under-recognised in this country. Of particular value is the box of recommendations on high-risk groups, testing and treatment.
However, I believe an important high-risk group has been omitted, a group which too often escapes the notice of the broader medical community. People with intellectual disability have been shown to be at particularly high risk of low vitamin D levels, reduced bone density and fractures.2-5 The reasons for this are multifactorial and include poor mobility, insufficient sun exposure, reduced muscle mass and strength, problems with dietary intake, and medications which interfere with vitamin D metabolism.3,4 There is also some evidence that people with intellectual disability are prone to premature ageing, together with the health problems associated with older age in the general population.3 Some conditions which cause or are associated with intellectual disability are also linked with hypogonadism and reduced peak bone mass.4
To add to all of this, several of the above risk factors, vitamin D deficiency itself, and the increased incidence of epilepsy in the population with intellectual disability, also result in an increased incidence of falls and trauma.5 This unfortunate combination of poor bone health and increased risk of falls and trauma results in a markedly increased incidence of fracture when compared with age- and sex-matched controls from the general population.2-5
In conclusion, people with intellectual disability, particularly those with poor mobility or who are also being treated for epilepsy, should be added to the list of high risk groups. It is likely that the relatively simple steps set out in the position statement (screening for vitamin D deficiency and supplementation) will result in substantial health benefits for this small but particularly vulnerable group of people.
References
- Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia. Vitamin D and adult bone health in Australia and New Zealand: a position statement. Med J Aust 2005; 182: 281-285. CHDCIJDJ
- Wagermans A, Fiolet J, van der Linden E, Menheere P. Osteoporosis and intellectual disability: is there any relation? J Intellect Disabil Res 1998; 42: 370-374. i1085790
- Foster B, Walkley J, Temple V. Bone mineral density status of women with intellectual disability. Adapted Phys Activity Q 2001; 18; 48-59. i1085792
- Schrager S. Osteoporosis in women with disabilities. J Womens Health 2004; 13: 431-437. i1085794
- Jancar J, Jancar M. Age-related fractures in people with intellectual disability and epilepsy. J Intellect Disabil Res 1998; 42: 429-433. i1085796