Severe Mental Illness as a risk factor for recorded diagnosis of osteoporosis and fragility fractures in people aged 50 and above: retrospective cohort study using UK primary care data.

Abstract

Severe Mental Illness (SMI) has been associated with reduced bone density and increased risk of fractures, although some studies have shown inconsistent results. Examine the association between SMI and recorded diagnosis of osteoporosis (OP) and fragility fracture (FF) in people aged ≥50years. Population-based cohort study; UK Primary care. We used anonymised primary care data (IQVIA Medical Research Database). Patients with a diagnosis of SMI aged 50-99y (2000-2018) were matched to individuals without SMI. We used Cox Proportional Hazards models to estimate Hazard Ratios (HR) and 95% Confidence Intervals (95%CI). We stratified analyses by sex and age, accounting for social deprivation, year, smoking, alcohol, and Body Mass Index (BMI). In total 444,480 people were included (SMI N=50,006; unexposed N=394,474). In men, diagnosis of SMI increased the likelihood of OP diagnosis, with differences mainly observed amongst the youngest (50-54y:HR=2.12;95%CI 1.61-2.79) and oldest (85-99y:HR=2.15;95%CI 1.05-4.37), and also increased the risk of FF across all ages. In women, SMI increased the risk of OP diagnosis only in those aged 50-54y:HR=1.16;95%CI 1.01-1.34, but increased the risk of FF across all ages. There were more than twice as many men with SMI with FF records than with OP diagnosis: FF:OP=2.10, compared to FF:OP=1.89 in men without SMI. The FF:OP ratio was 1.56 in women with SMI vs.1.11 in women without SMI. SMI is associated with increased likelihood of fragility fractures and osteoporosis underdiagnosis. Interventions should be considered to mitigate the increased risk of fractures in people with SMI.