Dr B Ramasubbu, Midlands Regional Hospital, writes that those with an ID are more at risk of poor bone health


Bone health is a topical issue in the medical world at present for all ages, races and both genders. Those with intellectual disability (ID) have many risk factors for poor bone health. Dietary deficiencies, poor mobility and low sunlight exposure and Vitamin D levels lower bone mineral density and increase the risk of osteoporosis (‘brittle bones’). With thinner, more brittle bones recurrent fractures can result, worsening quality of life and putting more obstacles in the path of individuals already dealing with more challenges than most.

As we enter the summer months it is useful to remember the importance that sunshine has on our bone health. Summer sunshine—wishful thinking and eternal optimism that THIS year will be a good summer has become an Irish way of life. Unfortunately, the duration of an ‘Irish summer’ is measured in days rather than months and with the chilling thoughts of a cold, dark winter ahead, every sunny day is something to be savoured and enjoyed. Not only that, exposing our skin to enough sunlight is crucial in maintaining good physical health and well being.

Vitamin D, sometimes called the ‘sunshine vitamin’, is formed when a person’s skin is exposed to sunlight and is essential for many functions in the body. One vital function of Vitamin D is in the absorption of calcium which, in turn, is necessary in the formation of healthy teeth and bones. Thus, Vitamin D and calcium deficiency can lead to complications such as osteoporosis, recurrent bony fractures and poor dental health. Also, Vitamin D deficiency has been linked with certain types of cancer and conditions such as diabetes, multiple sclerosis and tuberculosis.

Unfortunately, Ireland’s northern latitude means less sunlight is available during the winter months, and so Vitamin D levels can plummet during this time. This applies mainly to those with the luxury to venture outdoors, whilst those who are housebound or living in residential care can have low vitamin D levels all year round. For this reason, oral Vitamin D supplementation of 800 IU daily has been recommended to all adults with ID living in nursing homes and we await further data and recommendations for other groups with ID.

While sunlight is the natural way to obtain Vitamin D, startling low levels have been demonstrated across the Irish population and so a move to replenish this is underway. As more and more research shows the importance of Vitamin D and the complications of deficiency, more health care professionals are aware to ensure the needs of those at risk are met.

As well as Vitamin D, calcium intake is important to maintain bone health. This can be taken as a supplement and in a targeted diet. The best sources of calcium are dairy products such as yogurt, cheese and milk and, nowadays, many other sources such as orange juice are being supplemented with added calcium as well.

Unfortunately, immobility and a loss of mechanical stress on bone can lead to poor bone quality and osteoporosis, even in the presence of a normal calcium level. Hence, intensive physiotherapy and close bone-quality monitoring via DEXA scanning is necessary in bedbound patients, or fractures can result. Additional bone protection medications can be prescribed by medical physicians. These are used in selective cases to prevent or slow bone breakdown which results in osteoporosis .

Those with ID are at a high risk of poor bone health. Therefore, monitoring of Vitamin D and calcium levels is essential, with supplementation (where required) to maintain good bone health. With this in mind, careful management from general practitioners or early referral to a specialist can delay or prevent the onset of metabolic bone disease.


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