Background: Recent studies show that adults with intellectual disabilities (ID) have high incidence of major osteoporotic fracture, especially hip fracture. In those ≥ 50 years, women and men with ID have an approximately two and four times higher rate of hip fracture than women and men without ID. Increased awareness of osteoporotic fracture risk in ID may lead to wider use of antiresorptive drugs (bisphosphonates and denosumab) in this population. We aimed to compare, between people with and without ID, the incidence of 1) major side effects, namely medication related osteoporosis of the jaw (ONJ) and oesophagitis; 2) oral pathology, which can be a risk factor for ONJ.
Methods: Exploratory study investigating safety of first line osteoporosis medication within the population of a previous study comparing fracture incidence in people with and without ID in the GOLD database of the Clinical Practice Research Datalink 1998-2017.
Results: The percentage of people on antiresorptive drugs was identical in the ID and non ID group (1.4%). The number of individuals who developed ONJ and oesophagitis during the study was too low to allow an accurate estimate of incidence of the events and a comparison between the two groups. The incidence of any oral pathology was 119.31 vs 64.68/10000 person year in the ID vs non ID group.
Conclusions: Medication related ONJ and oesophagitis are rare in people with and without ID. There is no reason based on our findings to use antiresorptives differently in people with ID as in the rest of the population. However, the potential for side effects of antiresorptives will inherently increase with wider use of these drugs. Given the higher incidence of oral pathology in people with ID, which could put them at higher risk of ONJ, precautions should be taken to prevent this complication by attention to oral health.
Keywords: Intellectual disabilities; osteoporosis; antiresorptives; bisphosphonates; denosumab; osteonecrosis of the jaw; oesophagitis.
Fracture rates have recently been shown to be substantially higher in people with intellectual disabilities (ID). This finding is likely to lead to the wider use of bone strengthening (antiresorptive) agents in this group, namely bisphosphonates and denosumab. These drugs are effective at reducing the risk of fractures, but carry potential adverse effects. One of these is the rare but serious condition osteonecrosis of the jaw (ONJ). We studied general practice records to investigate whether the incidence of this problem is higher in people with ID taking these drugs. We also looked at the incidence of oral conditions that may put an individual at higher risk of it, including periodontitis, dental abscess, and tooth extractions. The recording of ONJ in people with ID was extremely low, no different from the general population in our study, although we were using general practice rather than dental records. However, dental problems that might predispose to it were recorded nearly twice as frequently in the group with ID. The other side effect we looked at was oesophagitis, which was not found to be more common in people with ID taking bisphosphonates. This study highlights the need to provide good oral hygiene, dental care and surveillance in people with ID receiving antiresorptive drug therapy.
Copyright: © 2022 Frighi V et al.