Prevalence of osteoporosis in community-dwelling individuals with intellectual and/or developmental disabilities.

OBJECTIVE: Measure central bone mineral density (BMD) in community-dwelling individuals with intellectual and/or developmental disabilities. DESIGN: A cross-sectional study. SETTING: A regional center providing outpatient medical, residential, and day activity services for individuals with intellectual and/or developmental disabilities. PARTICIPANTS: Documented BMD results were obtained for 298 community-dwelling individuals with intellectual and/or developmental disabilities. MEASUREMENTS: BMD by central dual-energy x-ray absorptiometry (DXA) on the participant's spine, converted into T-scores categories using CDC guidelines (T < or = -2.5 [osteoporotic]; -2.5 > T < -1.0 [osteopenic]; > or = -1.0 [normal]). Comparisons were made using multiple regression to determine significant independent risk factors for low BMD. RESULTS: Significant predictors were noted in the rates of osteoporosis attributable to subject age, race, and level of ambulation. No gender differences were noted for the rate of osteoporosis in this community sample of individuals with intellectual and/or developmental disabilities, nor were any differences noted for varying levels of mental retardation. Diagnostic differences were significant only for those individuals with a diagnosis of metabolic error, who had a significantly lower rate of osteoporosis than the rest of the study population. CONCLUSION: This study's findings regarding age, race, and level of ambulation are consistent with those of previous studies using an intellectually and/or developmentally disabled population as well as the general population at large. Our finding that the rate of osteoporosis among disabled males is higher than for males in the general population suggests a possible case-finding deficit for asymptomatic males in the general population. It is also interesting that the only diagnostic category observed to be statistically different from the group in general was metabolic error, a finding that warrants further investigation.

Medical care of adults with mental retardation.

Persons with mental retardation are living longer and integrating into their communities. Primary medical care of persons with mental retardation should involve continuity of care, maintenance of comprehensive treatment documentation, routine periodic health screening, and an understanding of the unique medical and behavioral disorders common to this population. Office visits can be successful if physicians familiarize patients with the office and staff, plan for difficult behaviors, and administer mild sedation when appropriate. Some syndromes that cause mental retardation have specific medical and behavioral features. Health issues in these patients include respiratory problems, gastrointestinal disorders, challenging behaviors, and neurologic conditions. Some commonly overlooked health concerns are sexuality, sexually transmitted diseases, and end-of-life decisions.

Autism: a medical primer.

Autistic disorder, a pervasive developmental disorder resulting in social, language, or sensorimotor deficits, occurs in approximately seven of 10,000 persons. Early detection and intervention significantly improve outcome, with about one third of autistic persons achieving some degree of independent living. Indications for developmental evaluation include no babbling, pointing, or use of other gestures by 12 months of age, no single words by 16 months of age, no two-word spontaneous phrases by 24 months of age, and loss of previously learned language or social skills at any age. The differential diagnosis includes other psychiatric and pervasive developmental disorders, deafness, and profound hearing loss. Autism is frequently associated with fragile X syndrome and tuberous sclerosis, and may be caused by lead poisoning and metabolic disorders. Common comorbidities include mental retardation, seizure disorder, and psychiatric disorders such as depression and anxiety. Behavior modification programs are helpful and are usually administered by multidisciplinary teams, targeted medication is used to address behavior concerns. Many different treatment approaches can be used, some of which are unproven and have little scientific support. Parents may be encouraged to investigate national resources and local support networks.

Successful Pain Management for the Recovering Addicted Patient.

Successful pain management in the recovering addict provides primary care physicians with unique challenges. Pain control can be achieved in these individuals if physicians follow basic guidelines such as those put forward by the Joint Commission on Accreditation of Healthcare Organizations in their standards for pain management as well as by the World Health Organization in their stepladder approach to pain treatment. Legal concerns with using pain medications in addicted patients can be dealt with by clear documentation of indication for the medication, dose, dosing interval, and amount provided. Terms physicians need to be familiar with include physical dependence, tolerance, substance abuse, and active versus recovering addiction. Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history. However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders-to maximize functional level while providing pain relief. However, to minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opioid dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use nonpsychotropic pain medications when possible. Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history. This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction.