A study of bone mineral density in adults with disability.
OBJECTIVE
To examine prevalence of low bone mineral density (BMD) among adults with disability, using World Health Organization diagnostic categories.


METHODS
Cross-sectional study.


METHODS
National Rehabilitation Hospital, Dublin, Ireland.


METHODS
Patients (N=255; 178 men, 77 women) who were disabled for at least 3 months because of acquired brain injury, spinal cord injury, other neurologic condition, or lower-limb amputation.


METHODS
None.


METHODS
Laboratory investigations including intact parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and sex hormones; and BMD of lumbar spine and at least 1 hip, measured by dual-energy x-ray absorptiometry and expressed as T scores and z scores.


RESULTS
Mean age +/- SD of participants was 48.7+/-15.6 years. Vitamin D deficiency, 25-OHD level 50 nmol/L or less, occurred in 154 (62.9%); insufficiency, a level between 51 and 72 nmol/L, occurred in 36 (14.7%). Based on T scores, 108 participants (42.4%) had osteopenia, and 60 (23.5%) had osteoporosis. A z score of -1 or less but more than -2 occurred in 76 (29.8%); a further 52 (20.4%) had a z score of -2 or less. On multiple linear regression analysis, ambulatory status and duration of disability were independent predictors of BMD at neck of femur (beta=.152, P=.007; beta=-.191, P=.001, respectively) and total proximal femur (beta=.170, P=.001; beta=-.216, P<.001, respectively).


CONCLUSIONS
Osteopenia and osteoporosis are very common in adults with disability participating in rehabilitation, compared with the general young adult population. Duration since onset of disability and mobility status are independent predictors of BMD at the hip. Bone health monitoring should form part of the long-term follow-up in adults with newly acquired disabilities.
Smith
Eimear M
EM
Department of Rehabilitation Medicine, National Rehabilitation Hospital, Dublin, Ireland. eimear.smith@nrh.ie
Comiskey
Catherine M
CM
Carroll
Aine M
AM
D015502:Absorptiometry, Photon; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D012959:Socioeconomic Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
D012739:Gonadal Steroid Hormones; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D