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People with intellectual disability (ID) are at higher risk of fractures, particularly of the hip. These are devastating events that cause persistent disability for the individual, extra work for carers, and a high cost to health and social care services. Such fractures are often preventable, and are due largely to osteoporosis (thinning of the bones), a very treatable condition. Osteoporosis occurs earlier in the life of a person with ID, at ages when bones would be stronger in the general population, and is particularly frequent in people with Down's syndrome. People with ID do not generally have their fracture risk assessed, and when they do, standard risk scores are poorly tailored to this population. Their risk therefore goes unrecognised, and few are offered the opportunity to prevent fractures.

This study aims to identify the most clinical and cost-effective strategy for assessing risk of fracture and offering preventive treatments in people with ID. Strategies investigated include: 1) evaluate fracture risk according to current methods (i.e. QFracture); 2) use of the IDFracture tool in all patients from age 40, with bone mineral density scan (DXA) in those near an intervention threshold; and 3) perform DXA in all patients aged 40 and above, with follow up according to result.