Bone Mineral Density and Osteoporosis Risk in Older Patients With Schizophrenia

Jung, Do-Un; Kelly, Deanna L.; Oh, Minkyung; Kong, Bo-Geum; Kang, J S; Lee, Seung‐Ju; Shim, Joo-Cheol

doi:10.1097/jcp.0b013e318221b123

Cited by 29 publications

(58 citation statements)

References 27 publications

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“…Seven studies were conducted in Europe [21–23, 36, 37, 40, 41], and three in Asia [35, 38, 39]. Sample sizes ranged from 14 [37] to 229 [38]. All but one of the included studies were cross-sectional, reporting a single measurement of BMD.…”

Section: Resultsmentioning

confidence: 99%

Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis

Gómez

Stubbs

Shirazi

et al. 2016

Curr Osteoporos Rep

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It remains unclear if differences in bone mineral density (BMD) exist at different skeletal sites between people with schizophrenia and age- and sex-matched healthy controls (HCs). Major databases were searched from inception until February 2016 for studies measuring BMD using dual-energy X-ray absorptiometry (DXA) at any skeletal site in individuals with schizophrenia. Ten studies investigating 827 people with schizophrenia (55.4 % female, 33.8 ± 9.7 years) and 1379 HCs (58.7 % female, 34.7 ± 9.1 years) were included. People with schizophrenia had significantly reduced BMD at the lumbar spine (standardised mean difference adjusted for publication bias (SMD) = −0.950 (95 % CI = −1.23 to −0.66, fail-safe number = 825) and hip (SMD = −0.534, 95 % CI = −0.876 to −0.192, fail-safe number = 186). A higher proportion of hyperprolactinaemia (β = −0.0102, p < 0.0001) and smokers (β = −0.0099, p = 0.02) moderated a larger reduced BMD at the lumbar spine. Further research is required to investigate if low bone mass and fractures can be prevented in people with schizophrenia.

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Section: Resultsmentioning

confidence: 99%

Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis

Gómez

Stubbs

Shirazi

et al. 2016

Curr Osteoporos Rep

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“…A recent literature review supports an association between AUDs and chronic health conditions in schizophrenia [111]. This and other reviews compared the prevalence rates of several chronic health conditions in individuals with schizophrenia with and without AUDs [112] and found higher prevalence rates of asthma, chronic obstructive pulmonary disease, coronary artery disease, HIV, osteoarthritis, hypertension and hyperlipidemia [109,111], but not diabetes or hepatitis C [111], in the comorbid patients. Key characteristics of the studies reviewed in this section are presented in Table 4.…”

Section: Physical Health Outcomesmentioning

confidence: 90%

“…Schizophrenia inpatients had higher rates of osteoporosis compared with controls, while comorbid AUDs were associated with reduced bone density [109] Hunt et al…”

Section: Review Smith and Csernanskymentioning

confidence: 98%

“…(2009) n = 80 SCZ_AUD (mean age: 42 years; SD: 9) Compared with SCZ [109], SCZ_AUD are at greater risk for hypertension, hyperlipidemia, osteoarthritis, asthma, COPD, coronary heart disease and HIV; diabetes and hepatitis C did not differ [111] Bowie et al…”

Section: Review Smith and Csernanskymentioning

confidence: 98%

“…Individuals with schizophrenia at the maintenance stage of the disorder are at greater risk for these chronic health conditions [106][107][108][109], with nearly 50% of these patients self-reporting such problems [110]. A recent literature review supports an association between AUDs and chronic health conditions in schizophrenia [111].…”

Section: Physical Health Outcomesmentioning

confidence: 98%

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Clinical implications of alcohol-use disorders in schizophrenia

Smith¹,

Csernansky²

2012

Neuropsychiatry

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Practice pointsThe clinical course of schizophrenia can be characterized by four stages: a premorbid stage often recognized in individuals with family histories of the disorder; a prodromal stage where subclinical symptoms are first expressed; the first episode of schizophrenia when psychosis first appears in its full form; and a maintenance stage of schizophrenia when there may be active or residual psychotic symptoms.Each stage of the clinical course of schizophrenia is characterized by elevated rates of alcohol-use disorders (AUDs).AUDs in this clinical population may be linked to neurobiological abnormalities within the reward system that may have functional implications for both addiction and schizophrenia.AUDs in this clinical population may also be linked with personality characteristics that predispose them to be sensitive to stress, to use ineffective coping skills and to turn to alcohol to relieve dysphoria.Research on AUDs in the first two stages, although minimal, suggests that prodromal individuals with AUDs are at risk for increases in perceptual abnormalities and strange behaviors.Research on AUDs in the latter two stages of schizophrenia suggests that AUDs are associated with exacerbated psychopathology, medication noncompliance, cognitive dysfunction, poor community functioning and poor physical health outcomes.The design of interventions for premorbid and prodromal individuals would benefit from considering the evidence-based implications of alcohol at these specific stages of the disorder.Naltrexone and disulfirate currently have US FDA approval as treatments for AUDs, and have shown some efficacy in individuals with schizophrenia. However, the use of these drugs has not yet been evaluated at all stages of the disorder.For reprint orders, please contact: reprints@futuremedicine.com

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Characterization of Hip Fractures Among Adults With Schizophrenia in Ontario, Canada

et al. 2023

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ImportanceEvidence suggests that individuals with schizophrenia are at an increased risk of hip fractures; however, the sex-specific burden of hip fractures among adults with schizophrenia has not been quantified and compared with the general population.ObjectiveTo describe sociodemographic and clinical characteristics of patients with hip fracture and schizophrenia and to quantify their sex-specific annual hip fracture rates relative to those without schizophrenia.Design, Setting, and ParticipantsThis repeated population-based, cross-sectional study leveraged multiple individually linked health administrative databases for patients in Ontario, Canada. We included patients aged 40 to 105 years with hip fracture–related hospitalization between April 1, 2009, and March 31, 2019. Statistical analysis was performed between November 2021 and February 2023.ExposureSchizophrenia diagnosis, ascertained using a validated algorithm.Main Outcomes and MeasuresThe main outcome was sex-specific age-standardized annual hip fracture rate per 10 000 individuals and annual percent change in age-standardized rates. Rates were direct adjusted to the 2011 Ontario population, and joinpoint regression analysis was performed to evaluate annual percent change.ResultsWe identified 117 431 hip fracture records; of these, there were 109 908 index events. Among the 109 908 patients with hip fracture, 4251 had schizophrenia and 105 657 did not. Their median age was 83 years (IQR, 75-89 years), and 34 500 (31.4%) were men. Patients with hip fracture and schizophrenia were younger at the index event compared with those without schizophrenia. Men had a median age of 73 vs 81 years (IQR, 62-83 vs 71-87 years; standardized difference, 0.46), and women had a median age of 80 vs 84 years (IQR, 71-87 vs 77-89 years; standardized difference, 0.32). A higher proportion of patients with vs without schizophrenia had frailty (53.7% vs 34.2%; standardized difference, 0.40) and previous fragility fractures (23.5% vs 19.1%; standardized difference, 0.11). The overall age-standardized rate per 10 000 individuals with vs without schizophrenia was 37.5 (95% CI, 36.4 to 38.6) vs 16.0 (95% CI, 15.9 to 16.1). Age-standardized rates were 3-fold higher in men with vs without schizophrenia (31.0 [95% CI, 29.5 to 32.6] vs 10.1 [95% CI, 10.0 to 10.2]) and more than 2-fold higher in women with vs without schizophrenia (43.4 [95% CI, 41.9 to 44.9] vs 21.4 [95% CI, 21.3 to 21.6]). Overall, joinpoint regression analysis identified a steady annual decrease of 0.7% (95% CI, −1.1% to −0.3%) in age-standardized rates for both study groups.Conclusions and RelevanceThe findings of this cross-sectional study suggest that individuals with schizophrenia experience an earlier age of onset and considerably higher rate of hip fractures compared with the general population, with implications for targeted fracture prevention and optimization of clinical bone health management over the course of their psychiatric illness.

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Bone Mineral Density and Osteoporosis Risk in Older Patients With Schizophrenia

Abstract: Our results emphasize that older patients with schizophrenia are at risk for low bone density. Cigarette smoking and alcohol abuse are associated with low bone density in patients with schizophrenia.

Cited by 29 publications

References 27 publications

Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis

Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis

Clinical implications of alcohol-use disorders in schizophrenia

Characterization of Hip Fractures Among Adults With Schizophrenia in Ontario, Canada

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