Focus on Secondary Condition Prevention: Osteoporosis Risk and Low Bone Mineral Density for People with Disabilities
By Jennifer Rowland, Ph.D.
Overview: What is Osteoporosis?
Osteoporosis is the most commonly diagnosed bone disease in the U.S., causing approximately 1.5 million fractures annually, some of which may lead to fatal complications (HHS, 2002). According to data from the National Health and Nutrition Examination Survey (NHANES), more than 10 million Americans over age 50 have been diagnosed with osteoporosis (7.8 million women and 2.3 million men). In addition to these figures, 33.6 million in the same age group have low bone mass which makes them at risk for the disease. The primary morbidity associated with osteoporosis is fracture risk.
Although women are at higher risk for osteoporosis, approximately one in seven males over age 80 is diagnosed with this secondary condition. Other risk factors associated with osteoporosis are: (1) postmenopausal status; (2) small bone frame; (3) low calcium intake; (4) increased intake of alcohol, caffeine and nicotine; and (5) sedentary lifestyle.
Osteoporosis is diagnosed using bone mineral density (BMD) measurements. BMD is obtained using dual energy x-ray absorptiometry or DXA, which measures multiple skeletal sites such as the spine and proximal femur. BMD is among several key predictors of fracture risk, which also include: (1) age (every five year increase raises the risk of hip fracture 50%); (2) weight (after age 25, every 20% decline in weight increases hip fracture risk by 70%); (3) history of fracture since age 50; and (4) having an existing spine fracture (HHS, 2002).
Recent Research Examining Osteoporosis in People with Disabilities
Despite the identification of osteoporosis as a secondary condition for people with disabilities that can be mitigated or prevented through early treatment (U.S. Surgeon General’s Report, 2005), little information is currently available regarding screening for osteoporosis in women with disabilities. Some classify osteoporosis as "one of the most commonly reported, yet frequently ignored secondary conditions in women with disabilities" (Smeltzer, 2005, p. 38S). The increase risk for falls among people with disabilities (Kinne, Patrick, & Doyle, 2004; Peabody & Stasikelis, 1999) as compared with the general population makes the lack of screening and diagnosis of osteoporosis especially disturbing.
Osteoporosis Screening for Peoeple with Disabilities
People who are diagnosed with specific types of disabilities that impair mobility or require steroid treatments make these groups especially vulnerable for developing osteoporosis. For example, frequent steroid use for people with multiple sclerosis or myasthenia gravis may predispose this population to osteoporosis risk. One study by Smeltzer, Zimmerman, & Capriotti (2005) included BMD screenings, a self-administered survey of osteoporosis risk factors, prevention strategies, and BMD screening recommendations for a group of 429 community residing women with disabilities. Results revealed that participants did not often report using osteoporosis risk reduction strategies, and only one third of the participants had received screening recommendations by their health care provider. Clearly, much needs to be done in terms of health education and promotion for screening and prevention in addition to treatment and lifestyle modifications that may be able to ameliorate some of the effects.