Christina Avgerinou, Kate Walters, Juan Carlos Bazo-Alvarez, David Osborn, Robert Michael West, Andrew Clegg, Irene Petersen
{"title":"严重精神疾病是 50 岁及以上人群骨质疏松症和脆性骨折记录诊断的风险因素:利用英国初级保健数据进行的回顾性队列研究。","authors":"Christina Avgerinou, Kate Walters, Juan Carlos Bazo-Alvarez, David Osborn, Robert Michael West, Andrew Clegg, Irene Petersen","doi":"10.3399/BJGP.2024.0055","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Severe mental illness (SMI) has been associated with reduced bone density and increased risk of fractures, although some studies have shown inconsistent results.</p><p><strong>Aim: </strong>To examine the association between SMI and recorded diagnosis of osteoporosis and fragility fracture in people aged ≥50 years.</p><p><strong>Design and setting: </strong>Population-based cohort study set in UK primary care.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>In total, 444 480 people were included (SMI <i>n</i> = 50 006; unexposed <i>n</i> = 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e861-e869"},"PeriodicalIF":5.3000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497150/pdf/","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Christina Avgerinou, Kate Walters, Juan Carlos Bazo-Alvarez, David Osborn, Robert Michael West, Andrew Clegg, Irene Petersen\",\"doi\":\"10.3399/BJGP.2024.0055\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Severe mental illness (SMI) has been associated with reduced bone density and increased risk of fractures, although some studies have shown inconsistent results.</p><p><strong>Aim: </strong>To examine the association between SMI and recorded diagnosis of osteoporosis and fragility fracture in people aged ≥50 years.</p><p><strong>Design and setting: </strong>Population-based cohort study set in UK primary care.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>In total, 444 480 people were included (SMI <i>n</i> = 50 006; unexposed <i>n</i> = 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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":55320,\"journal\":{\"name\":\"British Journal of General Practice\",\"volume\":\" \",\"pages\":\"e861-e869\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2024-11-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497150/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British Journal of General Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3399/BJGP.2024.0055\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"Print\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of General Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3399/BJGP.2024.0055","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"Print","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
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.
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.
期刊介绍:
The British Journal of General Practice is an international journal publishing research, editorials, debate and analysis, and clinical guidance for family practitioners and primary care researchers worldwide.
BJGP began in 1953 as the ‘College of General Practitioners’ Research Newsletter’, with the ‘Journal of the College of General Practitioners’ first appearing in 1960. Following the change in status of the College, the ‘Journal of the Royal College of General Practitioners’ was launched in 1967. Three editors later, in 1990, the title was changed to the ‘British Journal of General Practice’. The journal is commonly referred to as the ''BJGP'', and is an editorially-independent publication of the Royal College of General Practitioners.