| Sumario: | Background: People with intellectual disability often present atypically for various health conditions, making it challenging to identify concerns, particularly when communication challenges are also considered. Additionally, they may face barriers to healthcare access, resulting in many conditions going unnoticed. Health screening inequities are also evident in this population, and osteoporosis, a silent condition often only diagnosed postfracture, requires screening; however, if this does not happen, it may result in unnecessary fracture. Therefore the aim of this study is to identify predictors of osteoporosis in older adults with intellectual disability and examine potential inequity in the diagnosis of the condition. Methods: The study used data from the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS‐TILDA). Bone quality was measured using quantitative ultrasound (QUS). Logistic regression was performed to identify significant predictors of poor bone quality, including chronic health conditions, dietary intake, medication use and activity levels. Results: Out of 575 participants who completed QUS, osteoporosis prevalence was objectively measured at 41%, with a further 33.2% measured within the osteopenic range, but less than 2 in 10 had a doctor's diagnosis of osteoporosis. Reported Dual‐Energy X‐ray Absorptiometry screening uptake was low at 18.2%. Three major predictor variables of osteoporosis and osteopenia were found significant: difficulty walking 100 yards, taking antiepileptic drugs medicines and taking proton pump inhibitors. The model achieved an overall classification accuracy of 70.8% for osteopenia and 72.5% for identifying osteoporosis. Conclusion: The study highlights the different risk factors in people with intellectual disability, the potential for missed diagnoses and the likelihood there is inadequate screening. There is an urgent need for robust risk assessment and reasonable adjustments to ensure equitable screening and targeted preventive strategies. Clinicians must consider specific concerns for this population to avoid missed diagnoses and reduce the adverse effects of osteoporosis/osteopenia, such as an increased risk of fragility fractures. Keypoints: People with intellectual disability can have different ways of showing health problems, which makes it hard for doctors to know when something is wrong, especially when they cannot speak or find it hard to say how they feel.Sometimes, they also face difficulties in getting proper healthcare assessments, so some health issues may not be known. Poor bone health can go unnoticed, which could lead to people experiencing a broken bone.We tried to find out why some older adults with intellectual disability may have poor bone health and are at risk of breaking bones. We also looked at whether these individuals might not get examined for these problems.We studied information on 575 people in the study, and we found that 7 out of 10 people had poor bone health. Less than 2 out of 10 of them had it diagnosed by a doctor. Many of them had not been screened properly for this condition.We found three important things to help expect poor bone health: if someone has difficulty walking 100 yards, if they are taking certain medicines for their epilepsy, and if they are using certain types of medications for stomach problems. This is different to people without intellectual disability.It is important for healthcare providers to carefully assess the risks and make necessary changes to ensure everyone gets the right screenings and preventative care. By doing this, we can avoid problems like fractures, and we can close the gap of health inequalities between people with intellectual disability and those without.
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