Bipolar disorder and the risk of fracture: A nationwide population-based cohort study.

Abstract

BACKGROUND:

The co-primary aims are: 1) to compare the risk of fracture between adults with bipolar disorder and those without bipolar disorder; and 2) to assess whether lithium, anticonvulsants and antipsychotics reduce risk of fracture among individuals with bipolar disorder.

METHODS:

The analysis herein is a population-based retrospective cohort study, utilizing the National Health Insurance (NHI) medical claims data collected between 1997 and 2013 in Taiwan. We identified 3705 cases with incident diagnoses of bipolar disorder during study period and 37,050 matched controls without bipolar diagnoses. Incident diagnosis of fracture was operationalized as any bone fracture after the diagnosis of bipolar disorder or after the matched index date for controls.

RESULTS:

Bipolar patients had significantly higher risk of facture when compared to matched controls (17.6% versus 11.7%, respectively p<0.001). The hazard ratio (HR) was 1.33 (95% confidence interval [CI]＝1.23-1.48, p<0.001) after adjusting for covariates. Persons with bipolar disorder and a prior history of psychiatric hospitalization were had higher risk for bone fracture than those without prior history of psychiatric hospitalization when compared to match controls. Higher cumulative dose of antipsychotics or mood stabilizers did not increase the risk of fracture.

LIMITATIONS:

The diagnoses of bipolar disorder were not confirmed with structured clinical interview. Drug adherence, exact exposure dosage, smoking, lifestyle, nutrition and exercise habits were unable to be assessed in our dataset.

CONCLUSIONS:

Bipolar disorder is associated with increased risk of fracture, and higher cumulative dose of mood stabilizers and antipsychotics did not further increase the risk of fracture.

• Authors: Jian-An Su, Bi-Hua Cheng, Yin-Cheng Huang, Chuan-Pin Lee, Yao-Hsu Yang, Mong-Liang Lu, Chung-Yao Hsu, Yena Lee, Roger S McIntyre, Tzu Chin Lin, Vincent Chin-Hung Chen
• Journal: Journal of affective disorders (J Affect Disord) Vol. 218 Pg. 246-252 (08 15 2017) ISSN: 1573-2517 [Electronic] Netherlands
• PMID: 28477503 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier B.V. All rights reserved.

Chemical References

• Anticonvulsants
• Antimanic Agents
• Antipsychotic Agents
• Lithium Compounds

Topics

• Adult
• Anticonvulsants (therapeutic use)
• Antimanic Agents (therapeutic use)
• Antipsychotic Agents (therapeutic use)
• Bipolar Disorder (complications, drug therapy)
• Case-Control Studies
• Female
• Fractures, Bone (psychology)
• Humans
• Insurance, Health (statistics & numerical data)
• Lithium Compounds (therapeutic use)
• Male
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Taiwan