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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