Schizophrenia Associated With Bone Fragility and Fracture Risk

A comprehensive review and meta-analysis published in Translational Psychiatry has affirmed that individuals with schizophrenia have more fragile bones than those without the disorder, which carries an increased risk of fractures.

“Our findings regarding poor bone health in people with schizophrenia are concerning, given previous studies have indicated that this population experiences more adverse events following a fracture event, including longer length of hospitalization, higher risk of adverse perioperative events and acute post-operative complications, and in turn increased healthcare costs,” wrote Behnaz Azimi Manavi, Ph.D., of Deakin University in Geelong, Australia, and colleagues. “[I]t is not unrealistic to suggest that poorer outcomes associated with bone fragility contribute to the higher mortality rate in this population.”

Manavi and colleagues examined data from 29 studies that compared markers of osteoporosis in adults with schizophrenia with those of adults without the disorder; this included studies assessing bone mineral density, bone quality (strength and stiffness), bone turnover (the rate new bone is laid down and old bone removed), and/or risk of fracture. The studies encompassed 52,246 adults with schizophrenia along with over 4 million control individuals.

In total, the study data indicated that adults with schizophrenia have lower bone density (particularly at the hip), poorer bone quality, and higher rates of bone turnover; no significant differences between males and females were identified. A meta-analysis of seven studies that included fracture data found that adults with schizophrenia have a 32% increased risk of fracture, after adjusting for potential biases, again with no risk difference between males and females.

Manavi and colleagues noted that since schizophrenia is associated with premature mortality and the risks of osteoporosis increase with age, their findings may underestimate the true burden of schizophrenia on bone health in older adults.

“Further research is needed to evaluate the etiology of bone fragility in this population and recognize modifiable risk factors such as lifestyle or medications to reduce the potential risk for this patient group. Importantly, there is a need to develop guidelines for preventing risk factors and predicting fracture in people with schizophrenia,” they concluded.

For related information, see the Psychiatric News article “Study Calculates Disability Caused by Schizophrenia.”

(Image: Getty Images/iStock/Fertnig)

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One in Four People With Schizophrenia or Bipolar Have Multiple Physical Health Problems

A study in Lancet Psychiatry reports that adults with schizophrenia or bipolar disorder are more than twice as likely as those without these disorders to have multiple physical health problems like heart disease or diabetes. Further, the presence of multiple physical problems was more common in adults with schizophrenia or bipolar disorder than the presence of multiple psychiatric disorders.

“While health services and treatment guidelines often operate on the assumption that individuals have a single principal diagnosis, these results attest to the clinical complexity many people with severe mental illness face in relation to burden of chronic disease,” wrote Sean Halstead, M.D., of the University of Queensland in Brisbane, Australia, and colleagues.

Halstead and colleagues collected data from 82 observational studies of adults with schizophrenia spectrum disorder or bipolar disorder that assessed the prevalence of co-occurring physical or psychiatric conditions (though only a few studies examined both). The combined data included more than 1.6 million adults with one of these disorders and over 13 million adults with neither disorder (controls).

Overall, 25% of adults with schizophrenia or bipolar disorder had two or more physical health problems, while 13% had three or more physical health problems. In comparison, 14% of these adults had two or more psychiatric problems (on top of their index diagnosis). The prevalence of multiple physical health problems was roughly the same for schizophrenia and bipolar.

After analyzing data from 11 studies of physical problems that included controls, the researchers calculated that compared with controls, adults with schizophrenia or bipolar disorder had 2.4 times the odds of having two or more physical health problems. The burden was even higher in adults 40 or younger, who had 4 times the odds of multiple physical health problems.

Halstead and colleagues suggested that “a nuanced combination” of multiple factors likely contributes to the poor physical health of young adults with schizophrenia or bipolar disorder, including genetics, prenatal exposures, lifestyle choices, and psychotropic medication side effects. This greater lifetime exposure to poor physical health may explain the high rates of premature mortality seen in people with these two disorders.

For related information, see the Psychiatric News article, “Award Winner Describes Efforts to Improve Cognition in People With Bipolar Disorder.”

(Image: Getty Images/iStock/i_frontier)

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38-Year Study Assesses Violence and Premature Mortality in People With Schizophrenia

People with schizophrenia and related disorders have increased rates of suicide, premature mortality, and convictions for violent offenses, according to a report from British and Swedish researchers published Tuesday in Lancet.

The study compared 24,297 Swedish patients with their unaffected siblings and matched controls from the general population, assessing outcomes from 1972 through 2009. Within five years of diagnosis, 13.9% of male patients and 4.7% of female patients recorded one of those three adverse outcomes. Overall, those adverse outcomes were 7.5 times more likely compared with men in the general population and 11.1 times more likely for women, wrote Seena Fazel, M.D., an honorary consultant forensic psychiatrist in the University of Oxford’s Department of Psychiatry, and colleagues.

The authors assessed adverse outcomes in all three study groups and found that three risk factors present in all three cohorts predicted the adverse outcomes: drug use disorders, criminality, and self-harm. "Schizophrenia and related disorders are associated with substantially increased rates of violent crime, suicide, and premature mortality," they concluded. "Risk factors for these three outcomes included both those specific to individuals with schizophrenia and related disorders, and those shared with the general population. Therefore, a combination of population-based and targeted strategies might be necessary to reduce the substantial rates of adverse outcomes in patients with schizophrenia and related disorders."

"[T]he authors suggest that to best manage violence and suicide risk, we should perhaps now turn our attention to those factors evident across populations," added Eric Elbogen, Ph.D., an associate professor, and Sally Johnson, M.D., a professor of psychiatry at the University of North Carolina, in a related commentary. "In this way, we might not only reduce actual risk in people with schizophrenia, but appropriately place this in the context of violence reduction for society as a whole. The potential to achieve practical, evidence-based, and potentially less stigmatising interventions is one of the most exciting implications of this study."

To read more research on violence risk in those with schizophrenia, see the Psychiatric News articles, "Antisocial Behavior Raises Violence Risk in Some Psychosis Patients" and "Untreated Schizophrenia Increases Risk for Violence By Inmates." Also see "Systematic Suicide Risk Assessment for Patients With Schizophrenia: A National Population-Based Study" in Psychiatric Services.

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