Research Paper
Low bone mineral density among adults with disabilities in Taiwan: A cross-sectional descriptive study

https://doi.org/10.1016/j.dhjo.2015.03.010Get rights and content

Highlights

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    A population-based study with 572 community adults of disabilities.

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    A high prevalence of low bone mineral density among adults with disabilities.

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    Few participants possessed awareness of bone health and received early treatment.

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    It is necessary for osteoporosis interventions and prevention in this population.

Abstract

Background

Low bone mineral density (BMD) is a silent disease that can lead to osteoporosis and is a serious health problem worldwide. People with disabilities are especially at risk for fall-related death.

Objectives

To examine the prevalence of low bone mineral density and associated risk factors among adults with disabilities in Taiwan.

Methods

We conducted a population-based, cross-sectional study in 2013; the participants were 572 community adults with disabilities over the age of 20 years. Statistical analyses used to evaluate the association included chi-squared tests, ANOVA, and logistic regression.

Results

Over one-third of the participants had an intellectual disability, 26% physical disability, and the remainder had a combination of disabilities. Of the participants, 62.5% had abnormal bone mineral density, and 21.8% met the criteria for osteoporosis. After adjusting for potential confounding variables, the determinant risk factors for low bone mineral density were age (β = −.14, p = 0.002), gender (β = −.12, p = 0.004), and level of physical activity (β = .1, p = 0.024). The majority of participants with low BMD were not aware of abnormal bone density, and only 2.4% had received treatment.

Conclusions

This study identified a high prevalence of low bone mineral density among adults with disabilities; few of the participants possessed awareness of bone health, and very few received early treatment or information on prevention of osteoporosis. The enhancement of osteoporosis interventions and health promotion programs to prevent osteoporosis and related problems are necessary for this population.

Section snippets

Design, sample, and setting

This study was part of a health promotion program for community adults with disabilities led by a nursing team in collaboration with a private hospital and the Bureau of Health Promotion in Chiayi County, Taiwan. We used a cross-sectional descriptive design to establish the prevalence of BMD in the community. A community-based health screening survey was conducted between July and December 2013. Participants were selected by convenience samples from the registry of the government social welfare

Results

According to the T-scores and recommended BMD levels, Table 2 shows that 37.5% (n = 204) of the participants were categorized as normal (T > −.9), 62.5% (n = 344) below the normal standard (T score < −1.0), and 21.8% (n = 120) had a T score < −2.5. The majority of participants (93.2%) were not aware of the meaning of abnormal BMD, and only 2.4% (n = 14) had received any treatment. Systolic/diastolic blood pressure over 140/90 mm Hg was present for 26.1% and 25.4%, respectively. More than half

Discussion

The aim of the present study was to investigate the prevalence of low BMD among adults with disabilities and identify the associated risk factors. Three key findings emerged from this study. First, we found a high prevalence of low BMD in adults with disabilities, especially in men. Second, very few people were aware of low BMD problems, and very few received treatment for osteoporosis. Third, most disabled participants reported exercising infrequently.

Using QUS for the bone health screening,

Limitations

Despite the valuable findings in this study, some limitations should be noted. First, this study did not include all the risk factors associated with low BMD, such as nutrition.28 Further studies should include the assessment of calcium, vitamin D, and caffeine intake, in addition to the relationship of living arrangements to falls. Second, although QUS has some strengths (e.g., it is more portable and less expensive than DXA for screening), it cannot examine the spine and hip area. Individuals

Conclusions

This study examined from a nursing perspective the bone health among adults with disabilities living in community. We found a high prevalence of low BMD and a lack of awareness of bone health, adequate treatment, and preventive measures. Despite some unmodifiable risk factors, early detection of low BMD and referral for further diagnosis, increasing awareness of osteoporosis, encouraging physical activity, and initiating fall prevention interventions are important health strategies for adults

Acknowledgments

The authors would like to thank the individuals who participated in this study for their support in making this study possible. In addition, we would like to acknowledge the staff of the Chiayi County Health Bureau and the public health nurses for providing administrative support.

References (28)

  • Report on Physically and Mentally Disabled Citizens Living and Demand Assessment Survey

    (2014)
  • P. Benzinger et al.

    Pelvic fracture rates in community-living people with and without disability and in residents of nursing home

    J Am Med Dir Assoc

    (2012)
  • D. Dreyfus et al.

    Characteristics associated with bone mineral density screening in adults with intellectual disabilities

    J Am Board Fam Med

    (2014)
  • S. Heinrich et al.

    Cost-effectiveness of a multifactorial fall prevention program in nursing homes

    Osteoporos Int

    (2013)

    • Conflict of interest: The authors declare that they have no competing interests.

    Funding: The study was supported by a grant from the Chiayi County Health Bureau, Taiwan (GZRPF3C0191).

    Authors' contributions: MYC and PHC were involved with the conceptualization of the study, study design, data analysis, development of the discussion section, and editing of the final draft for publication. CYC participated in the conceptualization of the study and data collection. YJL collected data. All authors read and approved the final manuscript.

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