Department of Primary Care and Population Health, University College London, London.
Division of Psychiatry, University College London, London; Camden and Islington NHS Foundation Trust, London.
Br J Gen Pract. 2024 Nov 28;74(749):e861-e869. doi: 10.3399/BJGP.2024.0055. Print 2024 Dec.
Severe mental illness (SMI) has been associated with reduced bone density and increased risk of fractures, although some studies have shown inconsistent results.
To examine the association between SMI and recorded diagnosis of osteoporosis and fragility fracture in people aged ≥50 years.
Population-based cohort study set in UK primary care.
Anonymised primary care data (IQVIA Medical Research Database) were used. Patients with a diagnosis of SMI aged 50-99 years (2000-2018) were matched to individuals without SMI. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and age, accounting for social deprivation, year, smoking, alcohol, and body mass index.
In total, 444 480 people were included (SMI = 50 006; unexposed = 394 474). In men, diagnosis of SMI increased the likelihood of an osteoporosis diagnosis, with differences mainly observed among the youngest (aged 50-54 years: HR 2.12, 95% CI = 1.61 to 2.79) and the oldest (aged 85-99 years: HR 2.15, 95% CI = 1.05 to 4.37), and SMI increased the risk of fragility fractures across all ages. In women, SMI increased the risk of an osteoporosis diagnosis only in those aged 50-54 years (HR 1.16, 95% CI = 1.01 to 1.34), but increased the risk of fragility fractures across all ages. There were more than twice as many men with SMI with fragility fracture records than with an osteoporosis diagnosis: fragility fracture:osteoporosis = 2.10, compared with fragility fracture:osteoporosis = 1.89 in men without SMI. The fragility fracture:osteoporosis ratio was 1.56 in women with SMI versus 1.11 in women without SMI.
SMI is associated with an increased likelihood of fragility fractures and osteoporosis underdiagnosis. Interventions should be considered to mitigate the increased risk of fractures in people with SMI.
严重精神疾病（SMI）与骨密度降低和骨折风险增加有关，尽管一些研究结果并不一致。
研究≥50 岁人群中 SMI 与骨质疏松症和脆性骨折记录诊断之间的关系。
在英国初级保健中进行的基于人群的队列研究。
使用匿名的初级保健数据（IQVIA Medical Research Database）。年龄在 50-99 岁之间（2000-2018 年）的 SMI 诊断患者与没有 SMI 的患者相匹配。使用 Cox 比例风险模型估计风险比（HR）和 95%置信区间（CI）。根据性别和年龄进行分层分析，同时考虑社会贫困程度、年份、吸烟、饮酒和体重指数。
共纳入 444480 人（SMI = 50006；未暴露 = 394474）。在男性中，SMI 的诊断增加了骨质疏松症诊断的可能性，差异主要出现在最年轻（年龄 50-54 岁：HR 2.12，95%CI = 1.61-2.79）和最年长（年龄 85-99 岁：HR 2.15，95%CI = 1.05-4.37）的人群中，而 SMI 增加了所有年龄段脆性骨折的风险。在女性中，SMI 仅增加了 50-54 岁年龄组骨质疏松症诊断的风险（HR 1.16，95%CI = 1.01-1.34），但增加了所有年龄段脆性骨折的风险。患有 SMI 的男性中脆性骨折记录的人数是骨质疏松症诊断的两倍多：脆性骨折：骨质疏松症=2.10，而无 SMI 的男性脆性骨折：骨质疏松症=1.89。患有 SMI 的女性脆性骨折：骨质疏松症的比例为 1.56，而无 SMI 的女性为 1.11。
SMI 与脆性骨折和骨质疏松症漏诊的可能性增加有关。应考虑采取干预措施，以降低 SMI 患者骨折的风险。
