Alternative screening to DXA for osteoporosis in vulnerable populations 

Ms Anne Power, Advanced Nurse Practitioner, Chronic Disease Management, Wexford Residential Intellectual Disability Service, discussed alternative bone health screening for people with an intellectual disability, during the 2025 Irish Osteoporosis Society (IOS) Annual Medical Conference for Health Professionals.

She noted that while DXA scans remain the gold standard for the diagnosis of osteoporosis and bone density issues, they can be extremely difficult, or impossible, to perform in those with intellectual disabilities, due to a range of physical, communication, or behavioural factors.

Ms Power advocated the use of Echolight – a non-invasive, easy to use portable diagnostic and monitoring ultrasound device that measures bone mineral density – as an alternative to DXA scans in this population. 

Echolight, which is based on radiofrequency echographic multi-spectrometry (REMS) technology, is US FDA-approved, and does not produce ionising radiation. It is performed at the femoral hip and lumbar spine (L1–L4), takes about two minutes to perform, and the results are available immediately.

Ms Power noted that people with an intellectual disability can have increased risk factors for osteoporosis including sedentary lifestyle, medications such as anticonvulsants, antipsychotics, and proton pump inhibitors, poor nutrition, specific syndromes, and limited mobility. As a result, they are more likely to develop bone loss at a much younger age than the general population, leading to an increased risk of fractures, loss of independence and premature death. However, despite these increased risks, people with an intellectual disability are less likely to have accessed bone health screening – less than 40 per cent according to Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) data – and thus osteoporosis often goes undetected in this population.

Ms Power gave an update on her work (she has provided Echolight scans to approximately 250 people with intellectual disabilities nationwide) and research to date.

This research includes a feasibility study on using Echolight in the intellectually disabled population in Ireland.

The study, funded by the Nursing and Midwifery Planning and Development Unit Southeast, found that 96 per cent of participants (n=81/84) completed the Echolight REMS assessment.

Results-wise, 34 per cent (n=28/81) had a normal result, 38.3 per cent had osteopaenia, and 27.2 per cent had osteoporosis, “meaning almost two-thirds (n=53/81) had compromised bone health.”

“By implementing Echolight into practice, long-term we can significantly decrease the risk of fractures and loss of independence by screening all individuals with intellectual disabilities with accessible devices,” Ms Power said.

The impact of the study is that the IOS now endorses the use of Echolight specifically for those with intellectual disabilities, and it will be used by the IDS-TILDA in 2026, which will generate longitudinal data, she reported. Ms Power said she would like to see Echolight being made available throughout the country.