Severe mental illness as a risk factor for recorded diagnosis of osteoporosis and fragility fractures in people aged ≥50 years: retrospective cohort study using UK primary care data

Br J Gen Pract. 2024 Nov 28;74(749):e861-e869. doi: 10.3399/BJGP.2024.0055. Print 2024 Dec.

Abstract

Background: Severe mental illness (SMI) has been associated with reduced bone density and increased risk of fractures, although some studies have shown inconsistent results.

Aim: To examine the association between SMI and recorded diagnosis of osteoporosis and fragility fracture in people aged ≥50 years.

Design and setting: Population-based cohort study set in UK primary care.

Method: Anonymised primary care data (IQVIA Medical Research Database) were used. Patients with a diagnosis of SMI aged 50-99 years (2000-2018) were matched to individuals without SMI. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and age, accounting for social deprivation, year, smoking, alcohol, and body mass index.

Results: In total, 444 480 people were included (SMI n = 50 006; unexposed n = 394 474). In men, diagnosis of SMI increased the likelihood of an osteoporosis diagnosis, with differences mainly observed among the youngest (aged 50-54 years: HR 2.12, 95% CI = 1.61 to 2.79) and the oldest (aged 85-99 years: HR 2.15, 95% CI = 1.05 to 4.37), and SMI increased the risk of fragility fractures across all ages. In women, SMI increased the risk of an osteoporosis diagnosis only in those aged 50-54 years (HR 1.16, 95% CI = 1.01 to 1.34), but increased the risk of fragility fractures across all ages. There were more than twice as many men with SMI with fragility fracture records than with an osteoporosis diagnosis: fragility fracture:osteoporosis = 2.10, compared with fragility fracture:osteoporosis = 1.89 in men without SMI. The fragility fracture:osteoporosis ratio was 1.56 in women with SMI versus 1.11 in women without SMI.

Conclusion: SMI is associated with an increased likelihood of fragility fractures and osteoporosis underdiagnosis. Interventions should be considered to mitigate the increased risk of fractures in people with SMI.

Keywords: bone density; electronic health records; fragility fracture; osteoporosis; primary health care; severe mental illness.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Mental Disorders* / complications
  • Mental Disorders* / diagnosis
  • Mental Disorders* / epidemiology
  • Middle Aged
  • Osteoporosis* / complications
  • Osteoporosis* / diagnosis
  • Osteoporosis* / epidemiology
  • Osteoporotic Fractures* / diagnosis
  • Osteoporotic Fractures* / epidemiology
  • Primary Health Care*
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • United Kingdom / epidemiology

Grants and funding

Christina Avgerinou was funded by the National Institute for Health and Care Research (NIHR) Development and Skills Enhancement award and School for Primary Care Research (project: 634). The project was adopted by NIHR Applied Research Collaboration (ARC) North Thames. This report is independent research supported by NIHR ARC North Thames. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. David Osborn is supported by the University College London Hospitals NIHR Biomedical Research Centre and the NIHR ARC North Thames. This funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.