Mental disorders and psychotropic medication use are associated with an increased risk of osteoporotic fracture, according to data published in JAMA Psychiatry. In addition, depression and psychotropic medication use are potential risk indicators that are independent of FRAX risk score estimates.
Researchers from the Department of Psychiatry at the University of Manitoba in Winnipeg, Canada, and colleagues conducted a population-based cohort study using the FRAX fracture risk assessment tool to examine the association of mental disorders and related medication use with osteoporotic fracture risk in clinical practice.
The study included 68,730 men and women at least 40 years of age who were referred for a baseline dual-energy X-ray absorptiometry scan between January 1, 1996, and March 28, 2013. The main outcomes of the study were incident nontraumatic major osteoporotic fractures and hip fractures.
During 485,322 person-years of observation (median 6.7 years), 8.4% sustained an incident nontraumatic major osteoporotic fracture, 2.3% sustained an incident hip fracture, and 13.1% died.
In analyses adjusted for the FRAX scores, depression was associated with major osteoporotic fractures (adjusted hazard ratio [aHR], 1.39) and hip fracture (aHR, 1.43) before adjusting for medication use. However, these associations were not significant after adjustments for medication use. The use of selective serotonin reuptake inhibitors, antipsychotics, and benzodiazepines was independently associated with increased risk of major osteoporotic fractures and hip fractures.
The FRAX score underestimated the 10-year risk of major osteoporotic fractures by 29% and hip fracture by 51% among participants with depression. FRAX also underestimated the 10-year risk by 36% for the use of selective serotonin reuptake inhibitors, by 63% for the use of mood stabilizers, by 60% for use of antipsychotics, and by 13% for benzodiazepines.
FRAX underestimates the 10-year risk of hip fracture by 57% for the use of selective serotonin reuptake inhibitors, by 98% for use of mood stabilizers, by 171% for use of antipsychotics, and by 31% for the use of benzodiazepines. The assessment tool correctly estimated fracture risk in participants without mental disorders and those not taking psychotropic medications.
“Osteoporosis and mental disorders are highly prevalent conditions, and, as such, these findings have substantial implications for mental healthcare workers and primary care practitioners,” the study authors wrote. “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.”
- Bolton JM, Morin SN, Majumdar SR, et al. Association of mental disorders and related medication use with risk for major osteoporotic fractures. JAMA Psychiatry. 2017. 2017 Apr 19. doi:10.1001/jamapsychiatry.2017.0449