Sontam Tarun R, Alam Zaryab, Gupta Anuj, Chavda Hetsinhji, Basha Adil, Hamza Omar, Atassi Omar, Moukaddam Nidal
Department of Medical Education, Texas A&M School of Medicine, Dallas, TX, USA.
Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
J Orthop. 2025 May 23;67:203-208. doi: 10.1016/j.jor.2025.05.042. eCollection 2025 Sep.
This study examined fracture incidence in patients with bipolar disorder compared to those without and assessed fracture risk based on exclusive use of lithium, mood-stabilizing antiepileptics, antipsychotics, or antidepressants versus no medication use.
Using TriNetX, patients aged 18 or older were divided into bipolar and non-bipolar cohorts. The bipolar cohort was subdivided into five sub-cohorts: no medication use, exclusive lithium use, exclusive atypical antipsychotic use, exclusive mood-stabilizing antiepileptics use, and exclusive antidepressant use. The incidence of central, upper extremity, lower extremity, and "any" skeletal fractures (encompassing the previous three groups) were compared between the bipolar and non-bipolar cohorts, between males and females with bipolar disorder, and between patients aged 18-64 and aged 65 or older with bipolar disorder. A second analysis was performed to determine the incidence and relative risk of different fracture types based on exclusive medication use compared to no medication use.
Patients with bipolar disorder had a higher fracture risk than patients without, with an increased risk ranging from 0.43 % for upper extremity fractures to 2.41 % for any fractures. Male patients and patients aged 65 or older had a significantly higher risk of fractures compared to female patients and patients aged 18-64 (p < 0.0001 for all outcomes). Lithium use was associated with a reduced risk of central fractures (p = 0.0065) and any fractures (p = 0.0037). Patients using mood-stabilizing antiepileptics exhibited a lower risk of lower extremity fractures (p = 0.0002) and any fractures (p = 0.0003). Antipsychotic use was linked to a decreased risk of all fracture types (p < 0.0001). Antidepressant use was associated with an increased risk of upper extremity fractures (p < 0.0001) and any fractures (p < 0.0001).
Lithium, mood-stabilizing antiepileptics, and antipsychotics were associated with reduced fracture risk, while antidepressants increased fracture risk. Further research is needed to optimize bipolar disorder treatment strategies while minimizing fracture risk.
本研究对比了双相情感障碍患者与非双相情感障碍患者的骨折发生率，并基于单独使用锂盐、心境稳定剂类抗癫痫药、抗精神病药或抗抑郁药与未用药的情况评估了骨折风险。
利用TriNetX，将18岁及以上的患者分为双相情感障碍组和非双相情感障碍组。双相情感障碍组再细分为五个亚组：未用药组、单独使用锂盐组、单独使用非典型抗精神病药组、单独使用心境稳定剂类抗癫痫药组和单独使用抗抑郁药组。比较双相情感障碍组和非双相情感障碍组之间、双相情感障碍男性和女性之间、双相情感障碍18 - 64岁和65岁及以上患者之间的中枢、上肢、下肢和“任何”骨骼骨折（包括前三个组）的发生率。进行第二项分析以确定与未用药相比，基于单独用药情况的不同骨折类型的发生率和相对风险。
双相情感障碍患者的骨折风险高于非双相情感障碍患者，上肢骨折风险增加0.43%，任何骨折风险增加2.41%。男性患者和65岁及以上患者的骨折风险显著高于女性患者和18 - 64岁患者（所有结果的p < 0.0001）。使用锂盐与中枢骨折风险降低（p = 0.0065）和任何骨折风险降低（p = 0.0037）相关。使用心境稳定剂类抗癫痫药的患者下肢骨折风险较低（p = 0.0002）和任何骨折风险较低（p = 0.0003）。使用抗精神病药与所有骨折类型风险降低相关（p < 0.0001）。使用抗抑郁药与上肢骨折风险增加（p < 0.0001）和任何骨折风险增加（p < 0.0001）相关。
锂盐、心境稳定剂类抗癫痫药和抗精神病药与骨折风险降低相关，而抗抑郁药会增加骨折风险。需要进一步研究以优化双相情感障碍治疗策略，同时将骨折风险降至最低。
