Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
Psychiatry Res. 2024 Sep;339:116075. doi: 10.1016/j.psychres.2024.116075. Epub 2024 Jul 14.
Lithium is considered to be the most effective mood stabilizer for bipolar disorder. Evolving evidence suggested lithium can also regulate bone metabolism which may reduce the risk of fractures. While there are concerns about fractures for antipsychotics and mood stabilizing antiepileptics, very little is known about the overall risk of fractures associated with specific treatments. This study aimed to compare the risk of fractures in patients with bipolar disorder prescribed lithium, antipsychotics or mood stabilizing antiepileptics (valproate, lamotrigine, carbamazepine). Among 40,697 patients with bipolar disorder from 1993 to 2019 identified from a primary care electronic health record database in the UK, 13,385 were new users of mood stabilizing agents (lithium:2339; non-lithium: 11,046). Lithium was associated with a lower risk of fractures compared with non-lithium treatments (HR 0.66, 95 % CI 0.44-0.98). The results were similar when comparing lithium with prolactin raising and sparing antipsychotics, and individual antiepileptics. Lithium use may lower fracture risk, a benefit that is particularly relevant for patients with serious mental illness who are more prone to falls due to their behaviors. Our findings could help inform better treatment decisions for bipolar disorder, and lithium's potential to prevent fractures should be considered for patients at high risk of fractures.
锂被认为是治疗双相情感障碍最有效的情绪稳定剂。不断发展的证据表明，锂还可以调节骨骼代谢，从而降低骨折风险。虽然抗精神病药和情绪稳定型抗癫痫药会引起骨折的担忧，但对于与特定治疗相关的骨折总体风险知之甚少。本研究旨在比较锂、抗精神病药或情绪稳定型抗癫痫药（丙戊酸钠、拉莫三嗪、卡马西平）治疗的双相情感障碍患者的骨折风险。在英国的一个初级保健电子健康记录数据库中，从 1993 年至 2019 年确定了 40697 名双相情感障碍患者，其中 13385 名是情绪稳定剂（锂：2339；非锂：11046）的新使用者。与非锂治疗相比，锂与骨折风险降低相关（HR 0.66，95%CI 0.44-0.98）。当比较锂与催乳素升高和保留的抗精神病药以及个别抗癫痫药时，结果相似。锂的使用可能会降低骨折风险，对于因行为而更容易跌倒的严重精神疾病患者来说，这是一个特别相关的益处。我们的发现可以帮助为双相情感障碍做出更好的治疗决策，并且应该考虑锂预防骨折的潜力，以预防骨折风险高的患者发生骨折。
