Sex- and Age-Specific Incidence of Fractures in Mental Illness: A Historical, Population-Based Cohort Study
J Clin Psychiatry 2008;69(9):1398-1403
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To estimate risks of fracture at any site, and at
sites linked with osteoporosis, in mentally ill adults compared with the
Method: We created a community-based cohort by using the U.K.
General Practice Research Database, with follow-up from January 1987 through
April 2005. We investigated age- and sex-specific fracture risks in psychotic
illness (N = 4283), nonpsychotic affective disorder (N = 95,228), and any other
psychiatric condition (N = 49,439). Comparison cases were subjects with no
psychiatric code (N = 182,851); age-stratified (18-44 years, 45-74 years, >= 75
years) relative risks (RRs) were estimated by Poisson regression. Outcomes were
incident cases of fracture at any site, at the hip, and at the distal radius.
Results: Among all mentally ill women, highest RRs of fracture
at any site were in the youngest age group, whereas the strongest effects in
men were with older age. The highest raised risk of any fracture occurred in
premenopausal women with psychotic disorders (RR = 2.5, 95% CI = 1.5 to 4.3).
Hip fracture rates were raised in elderly women and men with psychiatric
illness and were especially high in women (RR = 5.1, 95% CI = 2.7 to 9.6) and
men (RR = 6.4, 95% CI = 2.6 to 16.1) with psychotic disorders at ages 45 to 74
years. Data were too sparse to estimate RR of distal radius fracture, although
risk was modestly (but significantly) higher among women with any mental
illness in each age group than the reference population, i.e., women with no
history of psychiatric disorder.
Conclusion: Raised risks of fracture in mental illness are
likely to be explained by a range of mechanisms. Further research is needed to
elucidate these mechanisms and to inform the development of targeted