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Williams LJ, Agustini B, Stuart AL, Pasco JA, Hodge JM, Samarasinghe RM, Bjerkeset O, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Berk M. Lithium use and bone health in women with bipolar disorder: A cross-sectional study. Acta Psychiatr Scand 2024; 149:332-339. [PMID: 38240178 DOI: 10.1111/acps.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/06/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Several psychiatric disorders and medications used to treat them appear to be independently associated with skeletal deficits. As there is increasing evidence that lithium possesses skeletal protective properties, we aimed to investigate the association between lithium use and bone health in a group of women with bipolar disorder. METHOD Women with bipolar disorder (n = 117, 20+ years) were recruited from south-eastern Australia. Bipolar disorder was confirmed using a clinical interview (SCID-I/NP). Bone mineral density (BMD; g/cm2 ) was measured at the spine, hip and total body using dual-energy x-ray absorptiometry and low bone mass determined by BMD T-score of <-1.0. Weight and height were measured, socioeconomic status (SES) determined and information on medication use and lifestyle factors self-reported. Linear and logistic regression were used to test associations between lithium and (i) BMD and (ii) low bone mass, respectively. RESULTS Thirty-five (29.9%) women reported current lithium use. Lithium users and non-users differed in regard to SES and BMD; otherwise, groups were similar. After adjustments, mean BMD among lithium users was 5.1% greater at the spine (1.275 [95% CI 1.229-1.321] vs. 1.214 [1.183-1.244] g/cm2 , p = 0.03), 4.2% greater at the total hip (0.979 [0.942-1.016] vs. 0.938 [0.910-0.966] g/cm2 , p = 0.03) and 2.2% greater at the total body (1.176 [1.148-1.205] vs. 1.150 [1.129-1.171] g/cm2 , p = 0.08) compared to participants not receiving lithium. Lithium users were also less likely to have low bone mass (22.9% vs. 43.9%, p = 0.031). Associations persisted after adjustment for confounders. CONCLUSION These data suggest lithium is associated with greater BMD and reduced risk of low bone mass in women with bipolar disorder. Research into the underlying mechanisms is warranted.
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Affiliation(s)
- Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Bruno Agustini
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Amanda L Stuart
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Julie A Pasco
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason M Hodge
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Rasika M Samarasinghe
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Shae E Quirk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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Stuart AL, Pasco JA, Berk M, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Mohebbi M, Williams LJ. Falls in community-dwelling women with bipolar disorder: a case-control study. BMC Psychiatry 2022; 22:620. [PMID: 36127652 PMCID: PMC9487100 DOI: 10.1186/s12888-022-04258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common occurrence in psychiatric hospital settings, however population-based research among individuals with psychiatric disorders, in particular bipolar disorder (BD) is scant. Thus, we aimed to investigate falls risk in community-dwelling women diagnosed with BD. METHODS Women with BD (cases, n = 119) were recruited from health care settings located in southeast Victoria, Australia. Age-matched controls (n = 357, ratio 3:1) without BD were participants in the Geelong Osteoporosis Study drawn from the same geographical region. Lifetime history of BD was identified by semi-structured clinical interview (SCID-IV/NP). Previous 12-month falls data were obtained via questionnaire. Information on mobility, alcohol use, general health, medication use, blood pressure, body mass index, socioeconomic status and use of a walking aid was collected. Generalised Estimating Equations, binary and ordinal logistic regression were used to determine the odds ratio (OR) and 95% confidence interval (CI) for falls following adjustment for confounders. RESULTS During the 12-month period, 34 (28.6%, median age 48.4 yr) cases and 70 (19.6%, median age 49.1 yr) controls reported one fall; 22 (18.5%) cases and 18 (5.0%) controls reported ≥ two falls (p < 0.001). Cases had 2.5-fold increased odds of at least one fall and 2.9-fold increased likelihood of increasing falls categories (0 vs. 1 vs. 2 +), compared to controls [adjOR 2.5, 95%CI (1.8, 3.4), adjOR OR 2.9, 95%CI (2.0, 4.1)]. CONCLUSION Risk of falls was greater among women with BD. Balance training could be a research and clinical focus for falls prevention programs among women with bipolar disorder to prevent the detrimental outcomes associated with falling.
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Affiliation(s)
- Amanda L. Stuart
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia
| | - Julie A. Pasco
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.414257.10000 0004 0540 0062Barwon Health University Hospital, Geelong, Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine-Western Health, The University of Melbourne, St Albans, Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Berk
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Psychiatry, The University of Melbourne, Parkville, Australia ,grid.418025.a0000 0004 0606 5526Florey Institute of Neuroscience and Mental Health, Parkville, Australia ,grid.488501.00000 0004 8032 6923Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Shae E. Quirk
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XMental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Mohammadreza Mohebbi
- grid.1021.20000 0001 0526 7079Faculty of Health, Deakin University, Burwood, Australia
| | - Lana J. Williams
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia
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Williams LJ, Stuart AL, Berk M, Brennan-Olsen SL, Hodge JM, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Chandrasekaran V, Cleminson JR, Pasco JA. Bipolar disorder and bone health: A case-control study. J Affect Disord 2022; 308:39-43. [PMID: 35398110 DOI: 10.1016/j.jad.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with significant psychological and physical comorbidity. Yet little is known about the bone health of individuals with BD. Thus, we aimed to investigate the association between BD and bone health in a population-based sample of women. METHODS Women with a history of BD (cases; n = 117) were recruited from public and private health care settings and controls, without BD, were drawn from the Geelong Osteoporosis Study (n = 909). BD was identified using a semi-structured clinical interview (SCID-I/NP). Bone mineral density (BMD) was measured at the spine, femoral neck and total body using dual energy x-ray absorptiometry, and bone quality by quantitative heel ultrasound and included the following parameters: Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA) and Stiffness Index (SI). Weight and height were measured and information on medication use and lifestyle was obtained. RESULTS Adjusted mean BMD among the cases was 4.3% lower at the hip and 1.6% lower at the total body compared to controls. Age was an effect modifier at the spine. Among women <50 years, mean spine BMD for cases was 3.5% lower than controls. No differences in spine BMD for those ≥50 years were detected. Cases also had a 1.0%, 3.2% and 7.8% lower adjusted mean SOS, BUA and SI compared to controls, respectively. LIMITATIONS Course, chronicity and recovery of BD were not explored in relation to bone health. CONCLUSION These data suggest BD is associated with low bone quantity and quality in women. Replication and research into underlying mechanisms is warranted.
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Affiliation(s)
- Lana J Williams
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia.
| | - Amanda L Stuart
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Victoria, Australia
| | - Sharon L Brennan-Olsen
- Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia; Deakin University, School of Health and Social Development, Geelong, Victoria, Australia; The University of Melbourne, Department of Medicine-Western Health, St Albans, Victoria, Australia; University of Melbourne and Western Health, Australian Institute for Musculoskeletal Science, St Albans, Victoria, Australia
| | - Jason M Hodge
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; Geelong Centre for Emerging Infectious Diseases, Geelong, Victoria, Australia
| | - Shae E Quirk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland; Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Jeremi Heikkinen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland; Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Vinoomika Chandrasekaran
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Jasmine R Cleminson
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; The University of Melbourne, Department of Medicine-Western Health, St Albans, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Mutz J, Young AH, Lewis CM. Age-related changes in physiology in individuals with bipolar disorder. J Affect Disord 2022; 296:157-168. [PMID: 34601303 DOI: 10.1016/j.jad.2021.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/02/2021] [Accepted: 09/12/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Individuals with bipolar disorder have a reduced life expectancy and may experience accelerated biological ageing. In individuals with bipolar disorder and healthy controls, we examined differences in age-related changes in physiology. METHODS UK Biobank recruited more than 500,000 participants, aged 37-73, between 2006 and 2010. Generalised additive models were used to examine associations between age and grip strength, cardiovascular function, body composition, lung function and heel bone mineral density. RESULTS The main dataset included 271,118 adults (mean age = 56.04 years; 49.60% females). We found statistically significant differences between cases and controls for grip strength, blood pressure, pulse rate and body composition, with standardised mean differences of up to -0.24 (95% CI -0.28 to -0.19). Evidence of differences in lung function, heel bone mineral density or arterial stiffness was limited. Case-control differences were most evident for age-related changes in cardiovascular function (both sexes) and body composition (females). Differences did not uniformly narrow or widen with age and differed by sex. For example, the difference in systolic blood pressure between male cases and controls was -1.3 mmHg at age 50 and widened to -4.7 mmHg at age 65. Diastolic blood pressure in female cases was 1.2 mmHg higher at age 40 and -1.2 mmHg lower at age 65. LIMITATIONS Analyses did not distinguish between bipolar disorder subtypes. Results may not generalise to other age groups. CONCLUSIONS Differences between bipolar disorder cases and controls were most evident for cardiovascular and body composition measures. Targeted screening for cardiovascular and metabolic health in middle age is warranted to potentially mitigate excess mortality.
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Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Medical and Molecular Genetics, Faculty of Life Sciences & Medicine, King's College London, London, UK
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