Increased risk of fracture in patients with bipolar disorder: a nationwide cohort study

Hsu, Chih Chao; Hsu, Yi‐Chao; Chang, Kuang-Hsi; Lee, Chang Yin; Chong, Lee Won; Wang, Yu Chiao; Hsu, Chung Y.; Kao, Chia Hung

doi:10.1007/s00127-016-1242-3

Cited by 21 publications

(16 citation statements)

References 41 publications

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“…Consistent with our findings of increased healthcare contacts due to bone fractures in adults, Su et al showed an increased risk of fractures in patients with BD compared with healthy controls . In addition, Hsu et al found that a BD diagnosis was an independent risk factor for bone‐fractures, regardless of sex, age, and comorbidities in a population of patients >16 years old . To our knowledge, this is the first study to investigate the incidence of bone fractures in children and adolescents diagnosed with BD, and in contrast to the findings in adults, children and adolescents did not have an increased incidence of bone fractures compared to PHCs.…”

Section: Discussionsupporting

confidence: 89%

Longitudinal outcomes in pediatric‐ and adult‐onset bipolar patients compared to healthy and schizophrenia controls

et al. 2019

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Objectives: Comparing outcomes of bipolar disorder (BD) with schizophrenia (SCZ) and psychiatrically healthy controls (PHC), contrasting pediatric-onset with adultonset disorders. Methods:A nationwide cohort study, including patients with an incident diagnosis of BD or SCZ registered in the Danish National Patient Registry and corresponding PHCs. Outcomes were (a) duration of hospitalization, (b) psychiatric admissions, (c) psychiatric outpatient contacts, (d) bone-fracture-related healthcare contacts, (e) self-harm-related healthcare contacts (including suicide and non-suicidal self-injuries), and (f) criminal charges. Incidence rate ratios (IRRs), adjusted for age at first psychiatric contact, substance abuse and parental psychiatric illness, were calculated, comparing pediatric-onset BD (5-17 years) and adult-onset BD (18-39 years) with age-and sex-matched SCZ patients and PHC.Results: Pediatric-onset BD (n = 349) performed better than 1:1-matched pediatriconset SCZ (n = 349) on all six outcomes (IRR = 0.30 for self-harm-related contacts (P < 0.001) to IRR = 0.86 for criminal charges (P = 0.05). Similar, but less pronounced results were observed comparing 1:1-matched adult-onset BD (n = 5515) with adultonset SCZ (n = 5515) IRR = 0.58 for psychiatric outpatient contact (P < 0.001) to IRR = 0.93 for criminal charges (P < 0.001), except for more bone-fracture-related contacts in adult-onset BD (IRR = 1.13, P < 0.01). Comparing pediatric-onset BD (n = 365) to 1:3-matched PHC (n = 1095), only self-harm-related contacts differed significantly (IRR = 2.80, P < 0.001). Conversely, comparing adult-onset BD (n = 6005) with 1:3matched PHC (n = 18 015), self-harm-related contacts (IRR = 16.68, P < 0.001), bone fractures (IRR = 1.74, P < 0.001), and criminal charges (IRR = 2.03, P < 0.001) were more common in BD.Conclusion: BD was associated with poorer outcomes than PHC, but better outcomes than SCZ. Furthermore, outcomes were more favorable in pediatric-onset BD when indirectly contrasted to adult-onset BD. K E Y W O R D Sage-of-onset, bipolar disorder, bone-fractures, criminality, hospitalization, outcome, outpatient, schizophrenia, self-harm | 515 FRAHM LAURSEN Et AL.

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Section: Discussionsupporting

confidence: 89%

Longitudinal outcomes in pediatric‐ and adult‐onset bipolar patients compared to healthy and schizophrenia controls

et al. 2019

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“…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%

“…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. They demonstrated that BD was an independent risk factor for fracture.…”

Section: Discussionmentioning

confidence: 99%

“…First, although the causal associations between three neuropsychiatric diseases and BMD were discussed in our study, we did not analyze the causal associations between three neuropsychiatric diseases and fractures. Fractures and their complications are severe and common clinical problems for the patients with schizophrenia, BD or AD [6][7][8], so it is necessary to take the causal associations into account in the further research. Second, the associations of the SNPs with schizophrenia and BMD were assessed in different subgroups of the population.…”

Section: Discussionmentioning

confidence: 99%

“…AD is also the primary cause of dementia in the elderly people [5]. Observational studies have suggested that these three neuropsychiatric diseases are associated with lower BMD and an increased risk of fracture [6][7][8]. However, because of the confounding factors between these three disorders and BMD, it is unclear whether they are etiologically relevant to BMD or are correlates of other unmeasured confounding factors.…”

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confidence: 99%

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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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Risk and outcomes of fracture in peripheral arterial disease patients: two nationwide cohort studies

et al. 2017

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Increased risk of fracture in patients with bipolar disorder: a nationwide cohort study

Abstract: Our study showed that patients with BD have a higher risk of subsequent fracture. Additional prospective clinical studies investigating the relationship between BD and fracture are warranted.

Cited by 21 publications

References 41 publications

Longitudinal outcomes in pediatric‐ and adult‐onset bipolar patients compared to healthy and schizophrenia controls

Longitudinal outcomes in pediatric‐ and adult‐onset bipolar patients compared to healthy and schizophrenia controls

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

Risk and outcomes of fracture in peripheral arterial disease patients: two nationwide cohort studies

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