2.50
Hdl Handle:
http://hdl.handle.net/10755/157885
Type:
Presentation
Title:
Fracture Incidence and Drug Use in Women with Developmental Disabilities
Abstract:
Fracture Incidence and Drug Use in Women with Developmental Disabilities
Conference Sponsor:Western Institute of Nursing
Conference Year:2006
Author:Watson, Kathleen, PhD, RN
P.I. Institution Name:University of Washington
Title:Lecturer
Contact Address:10306 9th Avenue NW, Seattle, WA, 98177, USA
Contact Telephone:206-616-1660
Co-Authors:Martha J. Lentz, RN, PhD and Kevin C. Cain, PhD
Purpose: Women with developmental disabilities may experience multiple risk factors for osteoporosis, including limited mobility, nutritional deficiencies and use of drugs which affect bone density. In addition, they may be at increased risk of falls and injuries due to problems with mobility, cognition, balance, seizure activity, or side effects of drugs. The purpose of this study was to evaluate any association between incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate (DMPA) and/or anti-epileptic drugs (AEDs) among women and girls with developmental disabilities. Osteoporotic fractures were defined as those which have been shown to be associated with decreased bone mineral density and which increase in incidence with age in the general population. For women, this algorithm includes all fractures except those of skull, face, hands and feet, fingers and toes, ankles and patellae. Methods: Cross-sectional population-based observational study of all non-institutionalized females with developmental disabilities age thirteen and older who received fee-for-service Medicaid in Washington State during 2002 (N=6773), using administrative data. Main Findings: In a sample of 6,773 females, 140 women (2%) had an osteoporotic fracture during 2002. Among 340 users of DMPA, 13 (3.8%) had an osteoporotic fracture with an odds ratio of 2.4 (CI 95%, 1.3-4.4) for fracture compared to non-users. Among 1909 users of anti-epileptic drugs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (CI 95%, 1.3-2.6) for fracture compared to non-users. We controlled for age and race (as Caucasian or non-Caucasian). Implications: These data suggest that use of either AEDs or DMPA by women with developmental disabilities is associated with significantly increased incidence of fracture in women of pre-menopausal age. Past or current use of DMPA or AEDs should be considered a risk factor indicating the need for early screening for osteoporosis along with other risk factors such as decreased mobility and history of previous fracture. Since the bone density effects of non enzyme-inducing AEDs such as valproate are unclear, use of any AED should be considered a risk factor. Nurses should encourage women with developmental disabilities, their parents or caregivers, to use DMPA for menstrual suppression only as a last resort until prospective data are available to guide its use in this population. Increased vigilance for fracture occurrence, especially in women who are unable to communicate their symptoms, is also indicated. Prospective research designed to further define the risk profiles for newer AEDs and for DMPA are needed. Testing of other means of menstrual management are also needed for women who have significant problems with menstrual hygiene or related seizure increases or behavioral problems. Support for this study was provided by NINR NIH 5 T32 NR07106-07 and by NINR NIH P30 NR04001.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFracture Incidence and Drug Use in Women with Developmental Disabilitiesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157885-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Fracture Incidence and Drug Use in Women with Developmental Disabilities</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Watson, Kathleen, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Washington</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Lecturer</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">10306 9th Avenue NW, Seattle, WA, 98177, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">206-616-1660</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">watsonkc@u.washington.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Martha J. Lentz, RN, PhD and Kevin C. Cain, PhD</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Women with developmental disabilities may experience multiple risk factors for osteoporosis, including limited mobility, nutritional deficiencies and use of drugs which affect bone density. In addition, they may be at increased risk of falls and injuries due to problems with mobility, cognition, balance, seizure activity, or side effects of drugs. The purpose of this study was to evaluate any association between incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate (DMPA) and/or anti-epileptic drugs (AEDs) among women and girls with developmental disabilities. Osteoporotic fractures were defined as those which have been shown to be associated with decreased bone mineral density and which increase in incidence with age in the general population. For women, this algorithm includes all fractures except those of skull, face, hands and feet, fingers and toes, ankles and patellae. Methods: Cross-sectional population-based observational study of all non-institutionalized females with developmental disabilities age thirteen and older who received fee-for-service Medicaid in Washington State during 2002 (N=6773), using administrative data. Main Findings: In a sample of 6,773 females, 140 women (2%) had an osteoporotic fracture during 2002. Among 340 users of DMPA, 13 (3.8%) had an osteoporotic fracture with an odds ratio of 2.4 (CI 95%, 1.3-4.4) for fracture compared to non-users. Among 1909 users of anti-epileptic drugs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (CI 95%, 1.3-2.6) for fracture compared to non-users. We controlled for age and race (as Caucasian or non-Caucasian). Implications: These data suggest that use of either AEDs or DMPA by women with developmental disabilities is associated with significantly increased incidence of fracture in women of pre-menopausal age. Past or current use of DMPA or AEDs should be considered a risk factor indicating the need for early screening for osteoporosis along with other risk factors such as decreased mobility and history of previous fracture. Since the bone density effects of non enzyme-inducing AEDs such as valproate are unclear, use of any AED should be considered a risk factor. Nurses should encourage women with developmental disabilities, their parents or caregivers, to use DMPA for menstrual suppression only as a last resort until prospective data are available to guide its use in this population. Increased vigilance for fracture occurrence, especially in women who are unable to communicate their symptoms, is also indicated. Prospective research designed to further define the risk profiles for newer AEDs and for DMPA are needed. Testing of other means of menstrual management are also needed for women who have significant problems with menstrual hygiene or related seizure increases or behavioral problems. Support for this study was provided by NINR NIH 5 T32 NR07106-07 and by NINR NIH P30 NR04001.</td></tr></table>en_GB
dc.date.available2011-10-26T20:17:55Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:17:55Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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