Intellectually disabled 2X more likely to have low vitamin D (shut-in) – Sept 2014

Vitamin D deficiency in patients with intellectual disabilities: prevalence, risk factors and management strategies

British Journal of Psychiatry online ahead of print September 25, 2014, doi: 10.1192/bjp.bp.113.143511
Valeria Frighi valeria.frighi at psych.ox.ac.uk, Alireza Morovat, Matthew T. Stephenson, Sarah J. White, Christina V. Hammond and Guy M. Goodwin
Valeria Frighi, MD, Department of Psychiatry, University of Oxford and Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Alireza Morovat, PhD, FRCPath, Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford; Matthew T. Stephenson, FRCPsych, MSysPsych, Oxfordshire Learning Disability NHS Trust (now Southern Health NHS Foundation Trust), Oxford; Sarah J. White, RGN, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford; Christina V. Hammond, BSc, Guy M. Goodwin, Dphil, FRCPsych, FMedSci, Department of Psychiatry, University of Oxford, Oxford, UK

Declaration of interest: V.F. and G.M.G. have received grants from the Baily Thomas Charitable Fund. G.M.G. has also received grants from Servier, and speaker honoraria or fees for advice from AstraZeneca, Cephalon/Teva, Eli Lilly, GSK, Lundbeck, Merck, Otsuka, Servier, Takeda and Sunovion.

Background: People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency.

Aims: To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments.

Method: Cross-sectional observational study followed by treatment evaluation.

Results: Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001).
In the intellectual disabilities group,

• winter season (P<0.0001),
• dark skin pigmentation (P<0.0001),
• impaired mobility (P = 0.002) and
• obesity (P = 0.001)

were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels.

Conclusions: Vitamin D deficiency is highly prevalent in people with intellectual disabilities,
partly because of insufficient exposure to sunlight.
Screening and treatment strategies, aiming to reduce these patients’ high fracture risk, should be introduced.
Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.

Publisher wants $33 for the PDF