Bipolar disorder and bone health: A systematic review

Chandrasekaran, Vinoomika; Brennan-Olsen, Sharon; Stuart, Amanda L; Pasco, Julie A.; Berk, Michael; Hodge, Jason M; Williams, Lana J.

doi:10.1016/j.jad.2019.02.013

Cited by 32 publications

(36 citation statements)

References 30 publications

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“…Anticonvulsants are used in the treatment of epilepsy and bipolar disorder, with both having been shown to be independently associated with increased fracture risk, although the mechanism of action has been thought to be due to falls related to seizures in epilepsy [39]. In a recent systematic review, however, bipolar disorder was associated with a 20-80% increased risk of fracture, independent of age, sex, medication and comorbidities [14]. Decreased physical activity and other modi able risk factors, such as diet, substance use, smoking, SES, sun exposure [40], medical comorbidities, polypharmacy and drug-induced metabolic imbalances [41,42] may also contribute to the overall decline in bone health.…”

Section: Discussionmentioning

confidence: 99%

“…The risk factors for osteoporosis are multifactorial and include age, poor lifestyle, inadequate nutrition, smoking, substance abuse, medication use and illnesses or conditions such as epilepsy, diabetes and bipolar disorder [1,13,14]. Several medications, including anticonvulsants such as valproate, have been associated with increased fracture risk [15].…”

Section: Introductionmentioning

confidence: 99%

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Anticonvulsant Use and Bone Health in a Population-based Study of Men and Women: Cross-sectional Data from the Geelong Osteoporosis Study.

Chandrasekaran

Pasco

Stuart

et al. 2020

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Background: Anticonvulsant use has been linked to bone deficits in specific patient populations. We studied the association between anticonvulsant use and bone health in a population-based sample of men and women.Methods: Data from 1996 people, 926 men (age:24-73y) and 1070 women (21-94y) participating in the Geelong Osteoporosis Study were included. Bone mineral density (BMD, g/cm2) of the PA-spine and total hip was measured using dual-energy X-ray absorptiometry (Lunar). Bone quality was determined using quantitative heel ultrasound (QUS). Anthropometry was conducted and socioeconomic status was determined. Medication and lifestyle information was obtained via questionnaire. Linear regression was used to test associations between anticonvulsant use and bone health before and after adjustment for potential confounders. Results: Seventeen (1.8%) men and 20 (1.9%) women reported anticonvulsant use. In men, anticonvulsant users had 9.1% lower adjusted mean BMD at the spine and hip compared to non-users. Body mass index (28.5 kg/m2) was an effect modifier at the spine. Anticonvulsant users also had 1.8% lower speed of sound (SOS), 10.6% lower broadband ultrasound attenuation (BUA) and 13.7% lower stiffness index (SI) compared to non-users. No significant association was observed between anticonvulsant use in women and spinal BMD, SOS, BUA or SI but BMD tended to be 5.8% lower at the hip compared to non-users. Conclusion: Our data suggest that bone quantity and quality, assessed using BMD and QUS, are lower for men and possibly women who use anticonvulsants. While further exploration into potential mechanisms is needed, our findings suggest that monitoring bone health among users of anticonvulsants is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anticonvulsant Use and Bone Health in a Population-based Study of Men and Women: Cross-sectional Data from the Geelong Osteoporosis Study.

Chandrasekaran

Pasco

Stuart

et al. 2020

Preprint

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“…Some inflammatory factors have been shown to have detrimental effects on BMD and increase the fracture risk through the promotion of osteoclast differentiation and apoptosis in osteoblast populations [27]. Other risk factors of bone loss, such as age, sex, genetic susceptibility, estrogen and daily activity, were also associated with schizophrenia, BD and AD [3,27,28]. However, it remained unclear whether these factors were causes or consequences of the three neuropsychiatric diseases.…”

Section: Discussionmentioning

confidence: 99%

“…BD refers to a group of affective disorders in psychiatry, which is characterized by multiple depressive or manic episodes [35]. Recent data have revealed increased fracture risk in patients with BD [7,28,36]. Hsu et al [7] conducted a retrospective population-based cohort study and found that patients with BD have a higher risk of subsequent fracture.…”

Section: Discussionmentioning

confidence: 99%

Schizophrenia, Bipolar Disorder, and Alzheimer’s Disease are not Causal Factors of Bone Mineral Density: A Mendelian Randomization Analysis

et al. 2019

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Until recently, it remains unclear whether schizophrenia, bipolar disorder (BD), and Alzheimer's disease (AD) is associated with bone mineral density (BMD). We aimed to investigate the causal effects of schizophrenia, BD and AD on BMD with Mendelian randomization (MR) analysis. Single-nucleotide polymorphisms (SNPs) strongly associated with these three neuropsychiatric diseases as instrumental variables were selected from genome-wide association studies in the MR Base database. We analyzed the effects of these SNPs on the femoral neck BMD (FN-BMD), lumbar spine BMD (LS-BMD) and forearm BMD (FA-BMD), and evaluated the heterogeneities and pleiotropy of these genetic variants. We also evaluated the potential confounding factors in the association between these three neuropsychiatric diseases and the BMD level. It was found that none of these genetic variants were significantly associated with BMD or confounding factors. Using these genetic variants, we did not find statistically significant causal effects of per unit increase in the log-odds of having schizophrenia, BD or AD with FN-BMD, LS-BMD and FA-BMD changes (e.g. schizophrenia and FN-BMD, MR-Egger OR 0.9673, 95% CI 0.8382 to 1.1163, p = 0.6519). The MR results also revealed that directional pleiotropy was unlikely to bias the causality (e.g., schizophrenia and FN-BMD, intercept = 0.0023, p = 0.6887), and no evidence of heterogeneity was found between the genetic variants (e.g., schizophrenia and FN-BMD, MR-Egger Q = 46.1502, I 2 = 0.0899, p = 0.3047). Our MR study did not support causal effects of increased risk of schizophrenia, BD and AD status with BMD level.

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“…Individuals with bipolar disorder are at increased risk of most disease groups, for example cardiovascular, metabolic, gastrointestinal and pulmonary disease, with such relationships having associated excess mortality 4. Research is now emerging to suggest that poor bone health is yet another potential comorbidity 5 6. Both clinically diagnosed unipolar depression and depressive symptoms have been associated with deficits in bone mineral density (BMD) and increases in fracture risk in both men and women across the adult age range,7–10 as has schizophrenia,11 alcohol use12 and eating disorders 13.…”

Section: Introductionmentioning

confidence: 99%

Bone health in bipolar disorder: a study protocol for a case–control study in Australia

et al. 2020

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IntroductionLittle is known about the bone health of adults with bipolar disorder, aside from evidence purporting bone deficits among individuals with other mental illnesses, or those taking medications commonly used in bipolar disorder. In this paper, we present the methodology of a case–control study which aims to examine the role of bipolar disorder as a risk factor for bone fragility.Methods and analysisMen and women with bipolar disorder (~200 cases) will be recruited and compared with participants with no history of bipolar disorder (~1500 controls) from the Geelong Osteoporosis Study. Both cases and controls will be drawn from the Barwon Statistical Division, south-eastern Australia. The Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition is the primary diagnostic instrument, and psychiatric symptomatology will be assessed using validated rating scales. Demographic information and detailed lifestyle data and medical history will be collected via comprehensive questionnaires. Participants will undergo dual energy X-ray absorptiometry scans and other clinical measures to determine bone and body composition. Blood samples will be provided after an overnight fast and stored for batch analysis.Ethics and disseminationEthics approval has been granted from Barwon Health Research Ethics Committee. Participation in the study is voluntary. The study findings will be disseminated via peer-reviewed publications, conference presentations and reports to the funding body.

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Bipolar disorder and bone health: A systematic review

Cited by 32 publications

References 30 publications

Anticonvulsant Use and Bone Health in a Population-based Study of Men and Women: Cross-sectional Data from the Geelong Osteoporosis Study.

Anticonvulsant Use and Bone Health in a Population-based Study of Men and Women: Cross-sectional Data from the Geelong Osteoporosis Study.

Schizophrenia, Bipolar Disorder, and Alzheimer’s Disease are not Causal Factors of Bone Mineral Density: A Mendelian Randomization Analysis

Bone health in bipolar disorder: a study protocol for a case–control study in Australia

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