Brendon Stubbs1, Fiona Gaughran2, Alex J Mitchell3, Marc De Hert4, Ross Farmer5, Andrew Soundy6, Simon Rosenbaum7, Davy Vancampfort8. 1. Education and Health, University of Greenwich, Southwood Site Avery Hill Road Eltham, London SE9 2UG, UK. Electronic address: b.stubbs@greenwich.ac.uk. 2. National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK. 3. Department of Psycho-oncology, Leicester General Hospital, Leicestershire Partnership Trust, Leicester, UK. 4. University Psychiatric Centre KU Leuven, Kortenberg, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium. 5. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK. 6. Department of Physiotherapy, University of Birmingham, Birmingham, B15 2TT, UK. 7. Musculoskeletal Division, The George Institute for Global Health and School of Public Health, University of Sydney, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia. 8. University Psychiatric Centre KU Leuven, Kortenberg, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium.
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.
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.
Authors: Davy Vancampfort; Joseph Firth; Christoph U Correll; Marco Solmi; Dan Siskind; Marc De Hert; Rebekah Carney; Ai Koyanagi; André F Carvalho; Fiona Gaughran; Brendon Stubbs Journal: World Psychiatry Date: 2019-02 Impact factor: 49.548
Authors: J Lally; P Gardner-Sood; M Firdosi; C Iyegbe; B Stubbs; K Greenwood; R Murray; S Smith; O Howes; F Gaughran Journal: BMC Psychiatry Date: 2016-03-22 Impact factor: 3.630
Authors: Marco Solmi; Andrea Murru; Isabella Pacchiarotti; Juan Undurraga; Nicola Veronese; Michele Fornaro; Brendon Stubbs; Francesco Monaco; Eduard Vieta; Mary V Seeman; Christoph U Correll; André F Carvalho Journal: Ther Clin Risk Manag Date: 2017-06-29 Impact factor: 2.423