Association Between Bipolar Disorder and Low Bone Mass: A Cross-Sectional Study With Newly Diagnosed, Drug-Naïve Patients

Li, Sujuan; Qui, Yan; Teng, Ziwei; Chen, Jindong; Kang, Dongyu; Tang, Hui; Xiang, Hui; Wu, Chujun; Tan, Yuxi; Wang, Lu; Yang, Yanfen; Wang, Bolun; Wu, Haishan

doi:10.3389/fpsyt.2020.00530

Cited by 13 publications

(11 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,2 Recent evidence suggests that bipolar disorder may be such a risk factor. [3][4][5] Bipolar disorder is a severe mental illness characterized by recurrent manic, hypomanic, depressive, and mixed episodes, which affects 1% to 2% of the population worldwide. 6,7 While manic and hypomanic episodes are defining for the disorder, it is the depressive episodes that account for the main burden of illness, [8][9][10] and depression is considered to be an important risk factor for poor bone health and osteoporosis, possibly mediated by lifestyle factors, such as poor diet and lack of physical activity or exercise.…”

mentioning

confidence: 99%

Association of Lithium Treatment With the Risk of Osteoporosis in Patients With Bipolar Disorder

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Osteoporosis, a systemic skeletal disorder associated with substantial morbidity and mortality, may be particularly common among individuals with bipolar disorder. Lithium, a first-line mood-stabilizing treatment for bipolar disorder, may have bone-protecting properties.OBJECTIVE To evaluate if treatment with lithium is associated with a decrease in risk of osteoporosis among patients with bipolar disorder. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included 22 912 adults from the Danish Psychiatric Central Research Register who received an initial diagnosis of bipolar disorder in the period from January 1, 1996, to January 1, 2019. For each patient with bipolar disorder, 5 age-and sex-matched individuals were randomly selected from the general population as reference individuals. Individuals with bipolar disorder prior to January 1, 1996, those with a diagnosis of schizophrenia or schizoaffective disorder prior to being diagnosed with bipolar disorder, and those with osteoporosis prior to the index date were excluded. Of the 114 560 reference individuals included, 300 were diagnosed with bipolar disorder during follow-up and were censored from the reference group fromn the date of diagnosis forward. For patients with bipolar disorder, treatment periods with lithium, antipsychotics, valproate, and lamotrigine were identified. Analyses were performed between January 2021 and January 2022.EXPOSURES Bipolar disorder and treatment with lithium, antipsychotics, valproate, and lamotrigine. MAIN OUTCOMES AND MEASURESThe primary outcome was osteoporosis, identified via hospital diagnoses and prescribed medications. First, incidence of osteoporosis was compared between patients with bipolar disorder and reference individuals (earliest start of follow-up at age 40 years) using Cox regression. Subsequently, incidence of osteoporosis for patients receiving treatment with lithium, antipsychotics, valproate, and lamotrigine, respectively, was compared with that of patients who were not treated with these medications.RESULTS A total of 22 912 patients with bipolar disorder (median [IQR] age, years; 12 967 [56.6%] women) and 114 560 reference individuals (median [IQR] age,] years; 64 835 [56.6%] women) were followed up for 1 213 695 person-years (median [IQR],.24] years). The incidence of osteoporosis per 1000 person-years was 8.70 (95% CI, 8.28-9.14) among patients and 7.90 (95% CI, 7.73-8.07) among reference individuals, resulting in a hazard rate ratio (HRR) of 1.14 (95% CI, 1.08-1.20). Among patients with bipolar disorder, 8750 (38.2%) received lithium, 16 864 (73.6%) received an antipsychotic, 3853 (16.8%) received valproate, and 7588 (33.1%) received lamotrigine (not mutually exclusive). Patients with bipolar disorder treated with lithium had a decrease in risk of osteoporosis (HRR, 0.62; 95% CI, 0.53-0.72) compared with patients not receiving lithium. Treatment with antipsychotics, valproate, and lamotrigine was not associated with reduced risk of osteoporosis. CONCLUSIONS AND RELEVANCEIn ...

show abstract

mentioning

confidence: 99%

Association of Lithium Treatment With the Risk of Osteoporosis in Patients With Bipolar Disorder

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Little is known about bone health in adults with bipolar disorder 43 and, to our knowledge, no research has examined heel bone mineral density in bipolar disorder. Research in Chinese adults found lower bone mineral density at other sites in drug-naïve bipolar disorder patients compared to healthy controls 44 . A 2019 review of three cohorts, one from the US and two from Taiwan, found higher fracture risk in individuals with bipolar disorder 45 but included no studies that directly examined bone mineral density.…”

Section: Discussionmentioning

confidence: 99%

Age-related changes in physiology in individuals with bipolar disorder

Mutz

Lewis

2021

Preprint

View full text Add to dashboard Cite

Objectives: Individuals with bipolar disorder have reduced life expectancy and may experience accelerated biological ageing. In individuals with bipolar disorder and healthy controls, we examined differences in age-related changes in physiology. Methods: UK Biobank recruited >500,000 participants, aged 37-73, between 2006-2010. Generalised additive models were used to examine associations between age and grip strength, cardiovascular function, body composition, lung function and bone mineral density. Analyses were conducted separately in males and females with bipolar disorder compared to healthy controls. Results: Analytical samples included up to 272,462 adults (mean age = 56.04 years, SD = 8.15; 49.51% females). We found statistically significant differences between bipolar disorder cases and controls for grip strength, blood pressure, pulse rate and body composition, with standardised mean differences of up to -0.238 (95% CI -0.282 to -0.193). There was limited evidence of differences in lung function, heel bone mineral density or arterial stiffness. Case-control differences were most evident for age-related changes in cardiovascular function (in both sexes) and body composition (in females). These differences did not uniformly narrow or widen with age and differed by sex. For example, the difference in systolic blood pressure between male cases and controls was -1.3 mmHg at age 50 and widened to -4.7 mmHg at age 65. Diastolic blood pressure in female cases was 1.2 mmHg higher at age 40 and -1.2 mmHg lower at age 65. Conclusions: Differences in ageing trajectories between bipolar disorder cases and healthy controls were most evident for cardiovascular and body composition measures and differed by sex.

show abstract

“…It is possible that some factors, such as low physical activity or medication with antiepileptics or SGA, could have turned significant in a larger study sample. However, previous studies on antipsychotics or antiepileptics and fracture risk have not found any significant associations [ 5 , 23 ], and low BMD have been shown to be more common in bipolar disorder already at the time of diagnosis [ 12 ]. It is possible that some of the reasons for low BMD and the increased risk of fractures in bipolar disorder should be searched for earlier in bipolar patients’ lives.…”

Section: Discussionmentioning

confidence: 99%

“…Unipolar depression and schizophrenia have both been associated with osteoporosis and reduced BMD [ 9 , 10 ]. The association between BD and osteoporosis have been less clear [ 11 ], but recent studies conclude that patients with BD compared to the general population have a higher risk of fractures and osteoporosis [ 4 , 5 , 6 , 7 , 12 ]. However, the risk of low BMD seems to be lower in bipolar depression than in unipolar depression and schizophrenia [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Bipolar Disorder and Bone Mineral Density Z-Scores in Relation to Clinical Characteristics and Lithium Medication

Lassas¹,

Norrbäck²,

Adolfsson³

et al. 2022

JCM

View full text Add to dashboard Cite

Bipolar disorder is associated with a long range of medical comorbidities, including migraine, diabetes, and cardiovascular disease. Bipolar disorder has also been associated with an increased risk of bone fractures. Osteoporosis is a reduction in bone mineral density, which leads to an increased risk for fragility fractures. Currently there is limited research on the association between bipolar disorder and osteoporosis. We aimed to study the association between high and low bone mineral density in relation to disease and treatment history in a sample of bipolar patients. We found that bipolar patients with high bone mineral density were more often on lithium medication, had a more active lifestyle and expressed lower current disease burden. Low mineral density was not associated with any of the addressed aspects of disease and treatment history. In conclusion our results support that patients on lithium treatment have higher bone mineral density; further studies are needed to address if lithium medication causes an increase in bone mineral density, and lowers the risk of bone fractures in bipolar disorder.

show abstract

Association Between Bipolar Disorder and Low Bone Mass: A Cross-Sectional Study With Newly Diagnosed, Drug-Naïve Patients

Cited by 13 publications

References 49 publications

Association of Lithium Treatment With the Risk of Osteoporosis in Patients With Bipolar Disorder

Association of Lithium Treatment With the Risk of Osteoporosis in Patients With Bipolar Disorder

Age-related changes in physiology in individuals with bipolar disorder

Bipolar Disorder and Bone Mineral Density Z-Scores in Relation to Clinical Characteristics and Lithium Medication

Contact Info

Product

Resources

About