Learning Disability Today
Supporting professionals working in learning disability and autism services

People with a learning disability have a higher rate of fractures

People with a learning disability have a higher rate of fractures compared with people of the same age and gender without a learning disability, according to new research.

The study by researchers at the University of Oxford and Oxford Health NHS Foundation Trust, published in eClinicalMedicine, was the most comprehensive study of its kind,

It found that fracture incidence starts to rise as people get older, but in those with a learning disability the rise begins many years earlier than expected.

The researchers looked at rates of fracture recorded either in general practice or in hospital records, over a 20-year period, 1998-2017. They compared rates between 43,000 individuals with a learning disability and 215,000 without, throughout the life course.

The types of bones most affected by the fractures points to early onset osteoporosis as the underlying basis for the increased rates. Hip fracture rates are particularly raised. Comparable rates of hip fracture occur approximately 15 to 25 years earlier in people with a learning disability. For example, at age 45, women with a learning disability have a rate of hip fracture similar to 60-year-old women without a learning disability. Forty-five-year-old men with a learning disability have similar rates of hip fracture to 70-year-old men without a learning disability.

Margaret Smith, Senior Statistician and Epidemiologist from the Nuffield Department of Primary Care Health Sciences, said: “We estimated that in 10,000 women over 50 years old with with a learning 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.”

Fractures are preventable if the risk is recognised and adequately managed

The authors said that hip fractures are devastating for the individual, often lead to permanent physical disability, can lead to premature death, and are extremely costly for NHS and social care. To a large extent, they are also preventable if the risk is recognised and adequately managed.

Ongoing research by the same team is investigating the reasons for such high rate of fracture in people with a learning disability. These could include impaired bone mass due to limitations in mobility and sedentary lifestyle, a tendency to fall, and accompanying medical conditions.

Active fracture prevention strategies should include promotion of safe physical exercise, reduction in the risk of falls, addressing co-existent medical disorders, and ensuring optimal vitamin D and calcium intake.

There could also be opportunities to reduce fracture rates through the wider use of existing drug therapies for osteoporosis. Meanwhile, clinical guidelines should be updated to include people with a learning disability in those at risk of osteoporotic fracture, particularly hip fracture.

Lead author Valeria Frighi, 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.”

The study was funded by the National Institute for Health and Care Research (NIHR), and endorsed by the Royal Osteoporosis Society, the Royal Mencap Society and the Down’s Syndrome Association.

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