Thursday, April 20, 2017

Patients Taking Psychotropic Medications Found to Be at Elevated Risk of Fractures

Psychotropic medication use increases risk for fractures—a heightened risk that may be missed by a commonly used fracture prediction tool, report the authors of a study published Wednesday in JAMA Psychiatry.

Among adults aged 40 years or older, the study found the risk of a major osteoporotic fracture was 1.43-fold higher in people taking selective serotonin reuptake inhibitors (SSRIs), 1.43-fold higher among people taking antipsychotics, and 1.15-fold higher in people taking benzodiazepines than people not taking these medications. 

“Osteoporosis and mental disorders are highly prevalent conditions, and, as such, these findings have substantial implications for mental health care workers and primary care practitioners,” wrote James Bolton, M.D., of the University of Manitoba (Manitoba, Canada) and colleagues in the paper.

Bolton and colleagues used the Manitoba Bone Density Program database (which contains information on all individuals in the province of Manitoba who have received bone mineral density scans) to assess how mental health influences the risk of major osteoporotic fractures—including hip, arm, and vertebrae fractures. The study cohort included 62,275 women and 6,455 men (average age of 64). Of the 68,730 individuals in the study, 12,982 (18.9%) had been diagnosed with a mental disorder. Psychotropic medication use was recorded in 11,938 (17.4%) of the sample, and 2,468 of these individuals (20.7%) were taking multiple psychotropics. 

The authors found that while a diagnosis of depression, anxiety, or schizophrenia was associated with a higher risk of major osteoporotic fracture, these associations were not significant once adjusted for medication use, suggesting the associations were driven by psychotropic use. Among the medications assessed, SSRIs, antipsychotics, and benzodiazepines increased the risk of both major osteoporotic fractures as a group and hip fractures alone. Tricyclic antidepressants and lithium did not increase the risk of either fracture type, while other antidepressants and mood stabilizers increased overall major osteoporotic fracture risk. 

When the study authors compared the total number of fracture incidents in adults taking psychotropic medications with the expected number based on a common fracture evaluation tool known as FRAX, they found that FRAX significantly underestimated fracture risk in this population. FRAX underestimated the 10-year risk of major osteoporotic fracture risk by 29% for those with depression, by 36% for those exposed to SSRIs, by 63% for those using mood stabilizers, by 60% for those using antipsychotics, and by 13% for those using benzodiazepines. 

“Diagnosed mental disorders and psychotropic medications identify subgroups at increased risk for fractures, and where this excess risk is not fully captured by the FRAX tool,” the authors concluded. “Broader public health initiatives and advocacy may be required to achieve better recognition and management of this elevated risk of fracture given that patients with psychiatric illness may not receive optimal treatment for comorbid physical health conditions.”

For related information, see the Psychiatric News article “Psychotropic Medication and Osteoporosis,” by Sylvia Karasu, M.D.

(Image: iStock/fotostorm)


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