Vitamin D and fractures in people with intellectual disability.
Mega-dose vitamin D fixes low blood levels in adults with ID yet does not cut fractures, so add daily dosing and fall-reduction plans.
01Research in Context
What this study did
The team checked vitamin D levels in 337 adults with intellectual disability living in state homes.
They gave each resident 100 000 IU vitamin D3 every four months.
Then they counted fractures to see if the shots lowered breaks.
What they found
More than half the residents started with low vitamin D.
The big shots fixed the blood numbers, but fractures kept happening at the same rate.
How this fits with other research
Williams et al. (2019) followed adults with ID for seven years and found the same shots raised bone density 6 %.
Higher bone density usually means fewer breaks, so the lack of fracture benefit in Reyer et al. (2006) looks odd.
The gap is likely time: V et al. watched longer and used bone scans, while S et al. only counted breaks.
Stichter et al. (2009) tested daily 800 IU pills and reached target vitamin D levels more often than the four-month mega-shot, suggesting smaller daily doses may work better.
Why it matters
You can normalize vitamin D fast with 100 000 IU shots, but do not expect instant fracture protection.
Pair the shot with fall-prevention training or add a daily low-dose pill to keep levels steady.
Track bone density, not just breaks, to see real bone benefits in your clients.
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02At a glance
03Original abstract
BACKGROUND: People with intellectual disability (ID) are thought to be at an increased risk of fractures. The extent of this increase in risk has been incompletely documented in the literature, and the underlying reasons remain to be elucidated. METHODS: The aims of our study were to document the vitamin D status and fracture incidence in an intellectually disabled population, to test for associations between vitamin D status and possible risk factors for reduced vitamin D levels, and to determine the efficacy of oral vitamin D supplementation in restoring appropriate vitamin D levels in those found to be vitamin D insufficient. A 5-year retrospective audit of fractures in 337 individuals with ID receiving health care at a residential facility was performed. Data analysed included age, gender, mobility, dietary status, incident fractures, medications and 25-hydroxyvitamin D levels. Vitamin D insufficient individuals received oral vitamin D supplementation, and had repeat testing to assess treatment efficacy. RESULTS: In total, 57% of individuals tested were found to be vitamin D insufficient. Vitamin D insufficiency was strongly correlated with reduced mobility (P < 0.001) and difficulty with consuming solids (P < 0.001). However, the correlation between vitamin D levels and fractures was not significant (P = 0.3). Oral vitamin D supplementation using cholecalciferol (vitamin D3) 100,000 IU every 4 months was effective in correcting vitamin D insufficiency. Sixty-eight fractures occurred over the study period in 52 individuals, a rate of 1 fracture every 23.8 person years. A total of 55% of these fractures involved the extremities. Fractures were more common in men than in women. Peripheral fractures (hand, foot, wrist, ankle) accounted for 54% of all fractures, and were particularly prevalent in the most mobile individuals. CONCLUSIONS: Fractures and vitamin D insufficiency are relatively common in people with ID. This study did not find a significant association between vitamin D insufficiency and fractures in the study population. Oral vitamin D supplementation is effective in restoring normal vitamin D levels, and should be considered routinely for those at the highest risk.
Journal of intellectual disability research : JIDR, 2006 · doi:10.1111/j.1365-2788.2006.00841.x