Risk factors for low bone mineral density in individuals residing in a facility for the people with intellectual disability.

BACKGROUND: Individuals with intellectual disability (ID) are known to have a high prevalence of both low bone mineral density (BMD) and fractures with significant attendant morbidity. Effective strategies aimed at reducing fractures will be facilitated by the identification of predisposing risk factors. METHODS: Bone mineral density was measured by quantitative ultrasound of the calcaneus performed on 79 women and 132 men residing in a facility for adults with ID. Multiple variable logistic regression analysis was performed to determine the significance of risk factors for low BMD. RESULTS: Mobility impairment consistently appeared to be a significant risk factor for low BMD regardless of age or sex and especially for middle-aged men with profound ID. Further risk was identified for postmenopausal women taking enzyme inducing anticonvulsant medications and middle-aged men who were either smokers or tended to be short. Hispanic followed by Caucasian origin also put middle-aged males at a greater risk than their African-American counterparts. CONCLUSIONS: Specific risk factors for low BMD, some of which have potential for modification, were identified in the study population. Targeted strategies for risk factor reduction may result in a decrease in the high rate of fractures among these individuals.

Low prevalence of abnormal cervical cytology in an institutionalized population with intellectual disability.

BACKGROUND: The present study was designed to determine the prevalence of abnormal cervical cytology in an institutionalized population with intellectual disability. METHOD: A retrospective review of charts for 162 women at a large state-owned facility was performed. Slides from 310 cervical Papanicolau smears were re-screened by a cytotechnologist and then reviewed by a pathologist. RESULTS: The prevalence of abnormal cytology (three out of 162 participants) and biopsy confirmed that the prevalence cervical dysplasia (one out of 310 smears) was low. CONCLUSION: The present preliminary study suggests that further investigation of the optimal interval for cervical cancer screening is warranted in this population.

Prevalence of low bone density in women with developmental disabilities.

This study was designed to assess the prevalence and severity of low bone mineral density in an institutionalized population of postmenopausal women (n = 79) with developmental disabilities, using quantitative ultrasound of the calcaneus. The results demonstrate that this population has a significantly lower quantitative ultrasound index (QUI) of the calcaneus compared with a referent population of age-matched control subjects without mental disabilities. We used the QUI T-score threshold of <-2.0 standard deviations (SDs) to define individuals at high risk for osteoporosis, and 82% of the study participants met this criterion. Furthermore, approx 43% of the population had a heel QUI that was more than 2 SDs below that of age-matched control subjects, consistent with a severe degree of demineralization.

Thioridazine: re-evaluating the risk/benefit equation.

The piperidine phenothiazine thioridazine has been in use for 40 years. As clinical experience has accumulated, scattered reports of sudden death and fatal or nonfatal arrhythmias during routine therapeutic use have been published. This paper reviews the case reports and retrospective studies that have been published to date. Four new case reports in which thioridazine in standard therapeutic doses is implicated as the cause of death or as contributing to the cause of death are presented. The author concludes that the accumulated clinical experience of thioridazine's potential for cardiotoxicity coupled with the availability of alternative, safer antipsychotic medications shifts the risk/benefit equation away from justifying widespread use.