Abstract
Background
People with schizophrenia experience increased rates of osteoporosis and may be at heightened risk of fractures. We conducted a systematic review and meta-analysis to investigate fractures among people with schizophrenia compared to people without mental illness.
Method
We systematically searched major electronic databases from inception until October 2014. Articles were included that reported the number of fractures in people with schizophrenia and a control group. Two independent authors conducted searches, completed methodological assessment and extracted data. Data were narratively synthesized, and a random-effects incidence rate ratio (IRR) meta-analysis was performed.
Results
Eight studies were included encompassing 48,384 people with schizophrenia (49.9–75.2 years, 41%–100% female) and 3,945,783 controls. The pooled adjusted rate of fractures per 1000 person-years was 5.54 [95% confidence interval (CI)=4.92–5.57] in people with schizophrenia and 3.48 (95% CI=3.39–3.64) in control participants. The comparative meta-analysis showed that people with schizophrenia experience an increased rate of fractures compared to control participants (IRR 1.72, 95% CI=1.24–2.39, I2= 49%; n= 168,914). There were insufficient data to conduct moderation analysis, but the narrative review consistently highlighted that antipsychotic medication was an important risk factor for fractures.
Conclusion
People with schizophrenia are at significantly increased risk of fractures. Future research is required to understand the mechanisms and should seek to validate fracture prediction algorithms used in the general population. Importantly, there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls-prevention strategies.
People with schizophrenia experience increased rates of osteoporosis and may be at heightened risk of fractures. We conducted a systematic review and meta-analysis to investigate fractures among people with schizophrenia compared to people without mental illness.
Method
We systematically searched major electronic databases from inception until October 2014. Articles were included that reported the number of fractures in people with schizophrenia and a control group. Two independent authors conducted searches, completed methodological assessment and extracted data. Data were narratively synthesized, and a random-effects incidence rate ratio (IRR) meta-analysis was performed.
Results
Eight studies were included encompassing 48,384 people with schizophrenia (49.9–75.2 years, 41%–100% female) and 3,945,783 controls. The pooled adjusted rate of fractures per 1000 person-years was 5.54 [95% confidence interval (CI)=4.92–5.57] in people with schizophrenia and 3.48 (95% CI=3.39–3.64) in control participants. The comparative meta-analysis showed that people with schizophrenia experience an increased rate of fractures compared to control participants (IRR 1.72, 95% CI=1.24–2.39, I2= 49%; n= 168,914). There were insufficient data to conduct moderation analysis, but the narrative review consistently highlighted that antipsychotic medication was an important risk factor for fractures.
Conclusion
People with schizophrenia are at significantly increased risk of fractures. Future research is required to understand the mechanisms and should seek to validate fracture prediction algorithms used in the general population. Importantly, there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls-prevention strategies.
| Original language | English |
|---|---|
| Pages (from-to) | 126-133 |
| Journal | General Hospital Psychiatry |
| Volume | 37 |
| Issue number | 2 |
| Early online date | 15 Jan 2015 |
| DOIs | |
| Publication status | Published - Mar 2015 |
Keywords
- Schizophrenia
- Psychosis
- Fracture
- Osteoporosis
- Fragility fracture
Access to Document
- Stubbs_Schizophrenia_risk_fractures_General_Hospital_Psychiatry_2015
NOTICE: this is the author’s version of a work that was accepted for publication. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published as Stubbs Brendon, Gaughran Fiona, Mitchell Alex J., De Hert Marc, Farmer Ross, Soundy Andrew, Rosenbaum Simon, Vancampfort Davy, Schizophrenia and the risk of fractures: A systematic review and comparative meta-analysis, General Hospital Psychiatry (2015), doi: 10.1016/j.genhosppsych.2015.01.004