Risk factors for osteoporosis in adults with serious mental illnesses: a comprehensive systematic review

Abstract

Background Mental illnesses are a major public health concern. In people with mental illnesses, the prevalence of medical conditions is often higher than the general population. Stigma and misconceptions of mental illnesses have led to the under-diagnosis and treatment of many medical conditions. One such medical condition is osteoporosis. Osteoporosis is a progressive, systematic metabolic bone disorder, characterized by low bone mineral density (BMD). The presence of osteoporosis has been associated with increased fragility and susceptibility to fractures, often leading to high health, social and economic burden. In order to effectively prevent or treat osteoporosis or related fractures in people with mental illnesses, one must aim to understand the risk factors so that targeted interventions may be developed to abolish or reduce the risk. Objectives The objective of the review is to synthesize the best available evidence regarding the risk factors for osteoporosis and fractures as a consequence of osteoporosis in adults aged 18 years and over. Inclusion criteria This review considered all study designs, including randomized controlled trials, cohort, case-control, correlational or observational study designs. Studies where participants were aged 18 years and over and which investigated factors contributing to osteoporosis or fractures in adults with mental illnesses were considered for inclusion. Search strategy A three-step search strategy was undertaken in this review to search for articles published in English from the year 2000 to 2012 (inclusive). An initial search of Medline and CINAHL was undertaken to identify keywords. Secondly, the keywords identified were used to search electronic databases namely, CINAHL, Medline, Cochrane Central Register of Controlled Trials, Ovid, PsycINFO, ScienceDirect, Scopus, Web of Science, Wiley of InterScience and ProQuest Dissertations & Theses. Thirdly, reference lists of the articles identified in the second stage were searched for other relevant studies. The final decision to include studies was made through the consensus of two independent reviewers. Selection criteria Articles were assessed by two independent reviewers for methodological validity using critical appraisal instruments adapted from JBI-MAStARI. Disagreements that arose between reviewers were resolved through discussion with a third reviewer. Data collection and synthesis An initial search revealed 242 records. After removing duplicates and reviewing the titles and abstracts of the records, 32 studies were found to have met the eligibility criteria and were subjected to critical appraisal. 26 were selected for inclusion in this systematic review and six were excluded. Of the 26 included studies, 13 were descriptive/case series studies and 13 were comparable cohort or case control studies. Specific details about the study methods, interventions, participants, instruments used and outcomes of significance to the review were extracted using data extraction tools developed by JBI. Main results A total of 26 articles were included in the review. Studies have shown that people with schizophrenia, bipolar disorders, depression and depression with borderline personality disorder were found to have increased risk of osteoporosis than healthy individuals as evidenced by their lowered bone mineral density. Across these diagnoses, higher occurrences of osteoporosis were found in the elderly and people who consumed psychotropic medications. Although females were also more likely to have increased risk of osteoporosis than males, the evidence between gender and osteoporosis were not consistent across all diagnoses, except schizophrenia and depression. Alcohol and drug use also impacted bone mineral density negatively, especially in people with schizophrenia. Conclusions The literature was reviewed to identify the risk factors that people with serious mental illnesses have for developing osteoporosis and fractures as consequences of osteoporosis. The risk factors were multifactorial ranging from personal factors, to mental health conditions and usage of drugs. People with mental illnesses risked developing osteoporosis. Many medications used to treat schizophrenia TRUNCATED AT 600 WORDS