S. K. Agarwal醫師以及N. K. Agarwal和 Malaspina醫師皆宣告沒有相關財務關係。
歐洲精神病協會第18屆歐洲精神病研討會：摘要374。發表於2010年2月28日。
Schizophrenics Have Increased Rate of Bone Fractures
By Jill Stein
Medscape Medical News
March 2, 2010 (Munich, Germany) — Schizophrenic patients sustain more than twice as many bone fractures as the general population, according to data released here at the European Psychiatric Association 18th European Congress of Psychiatry.
The results also showed that about a fourth of the fractures involved multiple sites and that males appeared to have more fractures than females.
“It is important to emphasize that our findings are preliminary, and we are expanding our study to hopefully further elucidate the cause of increased susceptibility to fractures in this population,” Shashi K. Agarwal, MD, an internist in private practice in East Orange, New Jersey, told Medscape Psychiatry.
Dr. Agarwal and his coauthor Neil K. Agarwal, a biomedical engineering student at Rutgers University in Piscataway, New Jersey, queried 115 consecutive patients who presented to their practice for a variety of medical conditions about prior fractures.
Dr. Shashi K. Agarwal and Neil K. Agarwal
Multiple Possible Causes Proposed
“Isolated reports suggest that schizophrenic patients may have a higher risk of bone fractures than the population at large,” Dr. Agarwal pointed out.
There may be multiple causes for this observation, including osteoporosis and other comorbidities, risky behavior because of the mental illness, unsteady gait, decreased cognition, environmental factors, malnutrition, long-term excessive smoking, alcohol, decreased mobility, and the effects of psychotropic drugs.
Dr. Agarwal said that he had noticed that many of his schizophrenic patients had exhibited scars or deformities resulting from prior fractures.
Accordingly, the present study was undertaken to permit a general assessment of previous bone fractures in an internist’s office.
Study participants ranged from 19 to 81 years of age. Overall, 79 patients (68.7%) were male and 36 (31.3%) were female. All patients were taking psychotropic drugs and under the care of a psychiatrist. “We believe our cohort represents a typical population of schizophrenics presenting to an internist’s office,” Dr. Agarwal said.
Prior Bone Fractures Found in Nearly Half of Schizophrenic Patients
Results showed that 51 patients (44%) reported a history of previous bone fractures. Thirty-eight patients with a history of bone fracture (33%) cited a history of single fractures, and the other 13 patients (11%) gave a history of multiple fractures.
Forty-three patients had extremity fractures and 13 had nonextremity fractures. Eight patients (61.5%) had only nonextremity fractures and 5 patients (38.5%) had nonextremity fractures in addition to extremity fractures.
Of the 43 extremity fractures, 27 (62.8%) involved fractures of the upper limbs, 23 (53.5%) involved fractures of the lower limbs, and 7 (16.3%) involved fractures of both the upper and lower limbs.
“The 44% rate of prior bone fractures in the study population is almost 2.5 times the 16% to 18% rate of bone fractures typically reported in the general population,” Dr. Agarwal observed.
He noted that although the medical literature seems to suggest that osteoporosis is probably the main cause of the increased rate of bone fractures in schizophrenic patients, he emphasized that he is not convinced.
“I am somewhat puzzled as osteoporosis would normally increase the tendency for low-impact bone fractures and these usually occur in the hips or vertebrae,” he said. “However, our patients had predominantly extremity fractures, which are generally high-impact fractures, thereby suggesting that other mechanisms may play a role.”
He added that data on the rates of osteopenia and osteoporosis in the study population, as well as prolactin levels, will be included in a later analysis.
Dr. Agarwal said that in addition to research aimed at identifying the precise role of osteoporosis in the increased frequency of bone fractures in the schizophrenic population, studies are also needed to examine the value of various interventions.
“Further study is necessary to see if medical intervention with a more balanced diet, regular weight-bearing exercise, avoidance of tobacco and alcohol, and increased exposure to sunlight and vitamin D supplementation would reduce this higher propensity toward fractures in schizophrenics,” he said.
He added that he hopes that his data, though preliminary, “will stimulate more work in this area and help prevent these injuries in this often underserved population.”
“This report should remind clinicians that bone density demineralization and an excess of fractures can accompany schizophrenia.” Dolores Malaspina, MD, professor and Steckler professor of psychiatry at NYU Langone Medical Center in New York City, told Medscape Psychiatry.
Unfortunately, fractures may sometimes be overlooked by practitioners, in part because patients may be poor historians, but also because patients often have reduced sensitivity to pain and may not have characteristic symptoms, she added.
An elevation in prolactin levels from antipsychotic medications may contribute to this risk, although elevated prolactin levels have also been observed in unmedicated patients, she said. Other risk factors include excessive tobacco exposure, inactivity, and poor nutrition.
Finally, she observed that patients with schizophrenia and polydipsia may be especially susceptible to osteoporosis and fractures.
Dr. S. K. Agarwal, Dr. N. K. Agarwal, and Dr. Malaspina have disclosed no relevant financial relationships.
European Psychiatric Association (EPA) 18th European Congress of Psychiatry: Abstract 374. Presented February 28, 2010.
