The British Journal of Psychiatry (2007) 190: 129-134. doi: 10.1192/bjp.bp.106.023671
© 2007 The Royal College of Psychiatrists
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Risk of hip fracture in patients with a history of schizophrenia

LOUISE HOWARD, PhD, MRCP, MRCPsych, GRAHAM KIRKWOOD, MSc and MORVEN LEESE, PhD

Health Services Research Department, Institute of Psychiatry, Kings College London, UK

Correspondence: Dr Louise Howard, PO 29, Health Services Research Department, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Email: l.howard{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background There is evidence of an association between decreased bone mineral density, schizophrenia, and prolactin-raising antipsychotic medication. However, it is not known whether this is clinically significant.

Aims To investigate whether patients with a history of schizophrenia are at increased risk of hip fracture.

Method In a case–control study, we compared cases of ‘hip fracture’ on the General Practice Research Database (n=16 341) with matched controls (n=29 889).

Results Hip fracture was associated with schizophrenia (OR=1.73; 95% CI 1.32–2.28), and prolactin-raising antipsychotics (OR=2.6; 95% CI 2.43–2.78), in the univariate analysis. In the multivariate analysis, prolactin-raising antipsychotics were independently associated with hip fracture but schizophrenia was not. A significant interaction between gender and antipsychotics was foundinthe association with hip fracture (P=0.042); OR=2.12 (95% CI1.73–2.59) for men, OR=1.93 (95% CI1.78–2.10) for women.

Conclusions The association between prolactin-raising antipsychotic medication and hip fracture may have serious implications for public health. Mental health service patients may require preventive measures including dietary and lifestyle advice.


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