Jian-An Su1, Bi-Hua Cheng2, Yin-Cheng Huang3, Chuan-Pin Lee4, Yao-Hsu Yang5, Mong-Liang Lu6, Chung-Yao Hsu7, Yena Lee8, Roger S McIntyre9, Tzu Chin Lin10, Vincent Chin-Hung Chen11. 1. Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan. 2. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Chiayi, Taiwan. 3. School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Taiwan. 4. Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital at Chiayi, Taiwan. 5. Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital at Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, at Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan. 6. Department of Psychiatry, Wan-Fang Hospital & School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 7. Department of Neurology, Kaohsiung Medical University and Hospital, Kaohsiung, Taiwan. 8. Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada. 9. Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada. 10. Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan. 11. Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: hjcch@yahoo.com.tw.
Abstract
BACKGROUND: The co-primary aims are: 1) to compare the risk of fracture between adults with bipolar disorder and those without bipolar disorder; and 2) to assess whether lithium, anticonvulsants and antipsychotics reduce risk of fracture among individuals with bipolar disorder. METHODS: The analysis herein is a population-based retrospective cohort study, utilizing the National Health Insurance (NHI) medical claims data collected between 1997 and 2013 in Taiwan. We identified 3705 cases with incident diagnoses of bipolar disorder during study period and 37,050 matched controls without bipolar diagnoses. Incident diagnosis of fracture was operationalized as any bone fracture after the diagnosis of bipolar disorder or after the matched index date for controls. RESULTS: Bipolar patients had significantly higher risk of facture when compared to matched controls (17.6% versus 11.7%, respectively p<0.001). The hazard ratio (HR) was 1.33 (95% confidence interval [CI]＝1.23-1.48, p<0.001) after adjusting for covariates. Persons with bipolar disorder and a prior history of psychiatric hospitalization were had higher risk for bone fracture than those without prior history of psychiatric hospitalization when compared to match controls. Higher cumulative dose of antipsychotics or mood stabilizers did not increase the risk of fracture. LIMITATIONS: The diagnoses of bipolar disorder were not confirmed with structured clinical interview. Drug adherence, exact exposure dosage, smoking, lifestyle, nutrition and exercise habits were unable to be assessed in our dataset. CONCLUSIONS: Bipolar disorder is associated with increased risk of fracture, and higher cumulative dose of mood stabilizers and antipsychotics did not further increase the risk of fracture.
BACKGROUND: The co-primary aims are: 1) to compare the risk of fracture between adults with bipolar disorder and those without bipolar disorder; and 2) to assess whether lithium, anticonvulsants and antipsychotics reduce risk of fracture among individuals with bipolar disorder. METHODS: The analysis herein is a population-based retrospective cohort study, utilizing the National Health Insurance (NHI) medical claims data collected between 1997 and 2013 in Taiwan. We identified 3705 cases with incident diagnoses of bipolar disorder during study period and 37,050 matched controls without bipolar diagnoses. Incident diagnosis of fracture was operationalized as any bone fracture after the diagnosis of bipolar disorder or after the matched index date for controls. RESULTS: Bipolar patients had significantly higher risk of facture when compared to matched controls (17.6% versus 11.7%, respectively p<0.001). The hazard ratio (HR) was 1.33 (95% confidence interval [CI]＝1.23-1.48, p<0.001) after adjusting for covariates. Persons with bipolar disorder and a prior history of psychiatric hospitalization were had higher risk for bone fracture than those without prior history of psychiatric hospitalization when compared to match controls. Higher cumulative dose of antipsychotics or mood stabilizers did not increase the risk of fracture. LIMITATIONS: The diagnoses of bipolar disorder were not confirmed with structured clinical interview. Drug adherence, exact exposure dosage, smoking, lifestyle, nutrition and exercise habits were unable to be assessed in our dataset. CONCLUSIONS:Bipolar disorder is associated with increased risk of fracture, and higher cumulative dose of mood stabilizers and antipsychotics did not further increase the risk of fracture.
Authors: Brendon Stubbs; Gayan Perara; Ai Koyanagi; Nicola Veronese; Davy Vancampfort; Joseph Firth; Katie Sheehan; Marc De Hert; Robert Stewart; Christoph Mueller Journal: J Am Med Dir Assoc Date: 2020-04-19 Impact factor: 4.669