Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis.

Lucia Gomez,Ayala Shirazi,Fiona Gaughran,Davy Vancampfort,Brendon Stubbs,John Lally

doi:10.1007/s11914-016-0325-0

Abstract

It remains unclear if differences in bone mineral density (BMD) exist at different skeletal sites between people with schizophrenia and age- and sex-matched healthy controls (HCs). Major databases were searched from inception until February 2016 for studies measuring BMD using dual-energy X-ray absorptiometry (DXA) at any skeletal site in individuals with schizophrenia. Ten studies investigating 827 people with schizophrenia (55.4 % female, 33.8 ± 9.7 years) and 1379 HCs (58.7 % female, 34.7 ± 9.1 years) were included. People with schizophrenia had significantly reduced BMD at the lumbar spine (standardised mean difference adjusted for publication bias (SMD) = −0.950 (95 % CI = −1.23 to −0.66, fail-safe number = 825) and hip (SMD = −0.534, 95 % CI = −0.876 to −0.192, fail-safe number = 186). A higher proportion of hyperprolactinaemia (β = −0.0102, p < 0.0001) and smokers (β = −0.0099, p = 0.02) moderated a larger reduced BMD at the lumbar spine. Further research is required to investigate if low bone mass and fractures can be prevented in people with schizophrenia.

Highlights

Osteoporosis is a progressive disease characterised by a marked loss as well as a change in the microstructure of bone tissue, resulting in a weakening of the skeletal structure [1]
Two studies did not provide the full details of bone mineral density (BMD) measurements [42, 43]
This study found that BMD decreased from 1.26 ± 0.19 to 1.23 g/cm2 across the 12-month treatment period for patients taking FGAs, whereas no significant changes were seen in patients treated with SGAs or in the control group

Summary

Introduction

Osteoporosis is a progressive disease characterised by a marked loss as well as a change in the microstructure of bone tissue, resulting in a weakening of the skeletal structure [1]. Osteopenia, not a disease category in itself, carries an increased risk of fracture [1]. 200 million people are estimated to have osteoporosis [2]. The fragility fractures commonly resulting from this condition are associated with an increase in morbidity and mortality, as well as a decrease in overall quality of life [3]. People with schizophrenia experience poorer general health outcomes than the general population, including an increased risk of osteoporosis [4].

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