Hip, vertebral, and wrist fracture risks and schizophrenia: a nationwide longitudinal study

Abstract

Background Fractures are a great health issue associated with morbidity, quality of life, life span, and health care expenditure. Fractures are correlated with cardiovascular disease, type 2 diabetes mellitus, cerebrovascular disease, and some psychiatric disorders. However, representative national data are few, and longitudinal cohort studies on the association between schizophrenia and the subsequent fracture risk are scant. We designed a nationwide population-based cohort study to investigate the association of schizophrenia with hip, vertebral, and wrist fractures over a 10-year follow-up. Methods Data of patients with schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification code 295) and matched over January 2000–December 2009) were extracted from Taiwan National Health Insurance Research Database. A Cox proportional-hazards regression model was constructed to calculate hazard ratios (HRs) for fractures between the schizophrenia and control cohorts. Results Of 2028 people with schizophrenia (mean age: 36.3 years, 49.4% female), 89 (4.4%) reported newly diagnosed fractures—significantly higher than the proportion in the control population (257, 3.2%; P = 0.007). The incidences of hip (1.2%, P = 0.009) and vertebral (2.6%, P = 0.011) fractures were significantly higher in the schizophrenia cohort than in the control cohort. In Cox regression analysis, hip (adjusted HR: 1.78, 95% confidence interval [CI]: 1.08–2.93) and vertebral (adjusted HR: 1.40, 95% CI: 1.01–1.95) fracture risks were significantly higher in patients with schizophrenia. Furthermore, a sex-based subgroup analysis revealed that the risk of hip fracture remained significantly higher in female patients with schizophrenia (HR: 2.68, 95% CI: 1.32–5.44) than in female controls. On the other hand, there was no significant interaction between effects of sex and schizophrenia on the risk of fractures. Conclusions Over a 10-year follow-up, hip and vertebral fracture risks were higher in the people with schizophrenia than in the controls. The risk of fractures in patients with schizophrenia does not differ between female and male.

The causal effect of schizophrenia on fractures and bone mineral density: a comprehensive two-sample Mendelian randomization study of European ancestry

“…In addition, our findings were identified on heel eBMD which did not represent BMD, despite ultrasound eBMD was increasingly recognized as a valid alternative to DXA [ 46 ] and successfully wielded in previous studies [ 16 , 18 , 47 ]. Though previous observational studies believed that schizophrenia would increase the risk of fracture and reduce BMD [ 5 , 29 , 48 ], our results still needed to be confirmed in future studies. Finally, only BMI was considered in MVMR as it was mostly correlated with the selected IVs, but the effects of other confounding factors such as age, and vitamin D were not included, which was worth further investigated.…”

“…Our study also found that schizophrenia had a genetic causal effect on the fracture of femur which was a position of the hip joint fracture. A recent 10-year cohort study suggested that the risk of hip fracture in schizophrenic patients was higher than that in the control group, while no difference was found in wrist fracture [ 5 ]. The evidence of schizophrenics prone to hip fractures compared to the general population also existed in a large population-cohort study [ 31 ].…”

“…Schizophrenia is a severe, complex and neuropsychiatric disorder with marked functional impairment posing a considerable societal burden [ 1 , 2 ], affecting about 1% of the world’s population. Compared with the general population, patients with schizophrenia experience poor general health outcomes, including increased risks of osteoporosis which is characterized by abnormally low bone mineral density (BMD), and fracture, especially hip fracture [ 3 – 5 ]. However, the pathogenesis of osteoporosis and fracture in patients with schizophrenia are not clearly defined.…”

Metabolites of Gut Microbiota and Possible Implication in Development of Diabetes Mellitus

“…DM is prevalent worldwide and affects the quality of life of many patients. − Major factors, including genetics, diets, lifestyle, stress, and environments, are considered to be closely related to the development of DM. Recently, emerging evidence has clearly demonstrated that gut microbiota may play a role in regulating an inflammatory response and insulin resistance through the actions of their metabolites (Figure ).…”

Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital

“…Stubbs et al ( 14 ) found that people with schizophrenia have a 50–100% increased risk of fracture compared to people without mental illness. Chu et al ( 15 ) found a significantly higher risk for hip and vertebral fractures in people with schizophrenia compared to controls. Zhu et al ( 16 ) recently showed that elevated depressive symptoms in Chinese people are associated with an increased risk for falls and hip fractures.…”