Schizophrenia and the risk of fractures

The systematic review and meta-analysis published by Brendon Stubbs and colleagues [1] provides some food for thought for healthcare providers and others looking at the wider implications following a diagnosis of schizophrenia. "People with schizophrenia are at significantly increased risk of fractures" was the conclusion reached based on the collected analysis of tens of thousands of people diagnosed with schizophrenia compared with nearly 4 million controls.

My immediate thought (and tweet) when I read this paper was whether this heightened risk of fracture may be connected to some of the various research done on the sunshine vitamin/hormone that is vitamin D and schizophrenia (see here) given the link between vitamin D and bone health. Acknowledging that correlation is not the same as causation and the requirement for some clarity on exactly how vitamin D might link into the presentation of schizophrenia, there is quite a body of evidence to suggest that a diagnosis of schizophrenia is in no way protective against vitamin D insufficiency or deficiency. Mmm, now where have I heard that before? Indeed, with reference to what other label have I read about bone health and vitamin D potentially being 'correlated'?

I might also add that in view of some evidence on the possible connection between vitamin D levels and dental caries for example, combined with the idea that certain dental conditions may be more likely in cases of schizophrenia [2], one might see something of a strengthening of the relationship between vitamin D status and schizophrenia?

But then there was this: "narrative review consistently highlighted that antipsychotic medication was an important risk factor for fractures." Very interesting. Indeed, after a short Twitter conversation with Brendon (@BrendonStubbs) about this, there was some mention of the idea that hyperprolactinemia might be something to consider (see a recent post) as a function of the link between certain antipsychotics and elevated levels of prolactin [3]. A quick scan of the research literature does indeed reveal that issues with bone mineral density (a potential feature increasing the risk of fracture) may well be present in cases of hyperprolactinemia in patients with schizophrenia [4]. Some interesting details to be sure.

Whatever the ways and means that might lead a person diagnosed with schizophrenia to show an increased risk of fracture, the paper from Stubbs et al offers a pretty clear message: "there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls-prevention strategies." Save that is, any further health inequality being thrust on the label of schizophrenia.

So: Leftfield and Open Up to close.

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[1] Stubbs B. et al. Schizophrenia and the risk of fractures: a systematic review and comparative meta-analysis. Gen Hosp Psychiatry. 2015 Jan 15. pii: S0163-8343(15)00005-5.

[2] Tani H. et al. Dental conditions in inpatients with schizophrenia: a large-scale multi-site survey. BMC Oral Health. 2012 Aug 18;12:32.

[3] Haddad PM. & Wieck A. Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management. Drugs. 2004;64(20):2291-314.

[4] Kinon BJ. et al. Bone loss associated with hyperprolactinemia in patients with schizophrenia. Clin Schizophr Relat Psychoses. 2013 Oct;7(3):115-23.

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Stubbs B, Gaughran F, Mitchell AJ, De Hert M, Farmer R, Soundy A, Rosenbaum S, & Vancampfort D (2015). Schizophrenia and the risk of fractures: a systematic review and comparative meta-analysis. General hospital psychiatry PMID: 25666994