Hip, vertebral, and wrist fracture risks and schizophrenia: a nationwide longitudinal study

Total knee arthroplasty in schizophrenia patients: early complications and cost in a propensity-matched national database study

INTRODUCTION

Studies investigating the link between mental health disorders and complications following total knee arthroplasty (TKA) have found worse outcomes in individuals with such disorders. Therefore, risk factors and outcomes following TKA in patients with schizophrenia should be better understood. This study aims to investigate cost and duration of hospital stay, inpatient complications, and mortality associated with TKA in patients with schizophrenia.

MATERIALS AND METHODS

Utilizing the NIS database from 2016 to 2019, patients that underwent TKA were selected using ICD-10 codes. The selected patients were classified into a schizophrenia or control group and cost, hospitalization length, complications, and mortality rates were compared between the two groups in an unmatched and matched analysis.

RESULTS

Our study dataset consisted of 558,371 patients that underwent a TKA during 2016 to 2019. 1,015 (0.2%) patients in the sample had a diagnosis of schizophrenia while the remaining 557,357 (99.8%) patients had no record of schizophrenia. An unmatched analysis found that schizophrenia patients had longer duration of hospital stay and greater charges incurred. Acute renal failure, myocardial infarction (MI), blood loss anemia, pneumonia, DVT, periprosthetic fracture, prosthetic dislocation, and periprosthetic infections were post-op complications with higher rates in the schizophrenia group. A matched cohort analysis found that schizophrenia patients still had longer duration of hospital stay and greater charges incurred. However, only acute renal failure, blood loss anemia, and pneumonia were found at higher rates in the schizophrenia group following TKA.

CONCLUSIONS

Schizophrenia patients had a significantly longer hospital stay and increased charges acquired during their stay compared to the control group following TKA. Acute renal failure, blood loss anemia, and pneumonia were medical complications with an increased risk following TKA in patients with schizophrenia in a matched analysis. Increased care during the perioperative period following TKA in individuals with schizophrenia is thus warranted.

The neglected association between schizophrenia and bone fragility: a systematic review and meta-analyses

Schizophrenia is associated with increased risk of medical comorbidity, possibly including osteoporosis, which is a public health concern due to its significant social and health consequences. In this systematic review and meta-analysis, we aimed to determine whether schizophrenia is associated with bone fragility. The protocol for this review has been registered with PROSPERO (CRD42020171959). The research question and inclusion/exclusion criteria were developed and presented according to the PECO (Population, Exposure, Comparison, Outcome) framework. Schizophrenia was identified from medical records, DSM-IV/5 or the ICD. The outcomes for this review were bone fragility [i.e., bone mineral density (BMD), fracture, bone turnover markers, bone quality]. A search strategy was developed and implemented for the electronic databases. A narrative synthesis was undertaken for all included studies; the results from eligible studies reporting on BMD and fracture were pooled using a random effects model to complete a meta-analysis. The conduct of the review and reporting of results adhered to PRISMA guidelines. Our search yielded 3103 studies, of which 29 met the predetermined eligibility criteria. Thirty-seven reports from 29 studies constituted 17 studies investigating BMD, eight investigating fracture, three investigating bone quality and nine investigating bone turnover markers. The meta-analyses revealed that people with schizophrenia had lower BMD at the lumbar spine [standardised mean difference (SMD) -0.74, 95% CI -1.27, -0.20; Z = -2.71, p = 0.01] and at the femoral neck (SMD -0.78, 95% CI -1.03, -0.53; Z = -6.18, p ≤ 0.001). Also observed was a higher risk of fracture (OR 1.43, 95% CI 1.27, 1.61; Z = 5.88, p ≤ 0.001). Following adjustment for publication bias, the association between schizophrenia and femoral neck BMD (SMD -0.63, 95% CI -0.97, -0.29) and fracture (OR 1.32, 95% CI 1.28, 1.35) remained. Significantly increased risk of bone fragility was observed in people with schizophrenia. This association was independent of sex, participant number, methodological quality and year of publication.

Long-term second-generation antipsychotics decreases bone formation and resorption in male patients with schizophrenia

RATIONALE

Patients with schizophrenia with second-generation antipsychotics (SGAs) treatment have shown an increased risk of bone fragility and susceptibility to fracture; however, it is still unclear whether this risk is derived from the effect of antipsychotics on balance of bone metabolism.

OBJECTIVES

We investigated the changes of two bone turnover biomarkers (BTMs) concentrations in people with schizophrenia receiving SGAs: procollagen type I aminoterminal propeptide (PINP) and C-terminal telopeptide of type I collagen (CTX-1) as BTMs of osteogenesis and bone resorption, respectively, to explore how antipsychotics contribute to bone fragility.

METHODS

We recruited 59 Chinese male patients with schizophrenia (32 drug-naïve first-episode (DNFE) patients and 27 chronic patients) to undergo 8 weeks SGAs treatment. Fasting peripheral blood samples of pre- and posttreatment were collected, plasma levels of PINP and CTX-1 were measured.

RESULTS

The interaction effects of group and time on PINP and CTX-1 concentrations were found (P = .016 and P = .008). There was a significant decrease for both BTMs concentrations of the posttreatment compared to the pretreatment (P<.001 and P = .003). Chronic patients had significantly higher changes of BTMs concentrations compared to DNFE patients (P = .048 and P = .024). There was a positive correlation of the two BTMs of pretreatment with disease course in DNFE group (r = .37, P = .039;r = .38, P = .035) and a negative correlation of PINP of pretreatment with age in the chronic group (r=-.40, P = .039).

CONCLUSION

Long-term SGAs medication inhibited osteogenesis in a dose- and time-dependent manner and damaged the balance of bone formation and bone resorption.

The causal effect of schizophrenia on fractures and bone mineral density: a comprehensive two-sample Mendelian randomization study of European ancestry

BACKGROUND

Schizophrenia was clinically documented to co-occur with fractures and aberrant bone mineral density (BMD), but the potential causal relationship remained unclear. This study aimed to test the causal effects between schizophrenia and fractures as well as aberrant BMD by conducting Mendelian randomization (MR) analyses.

METHODS

Two-sample MR was utilized, based on instrumental variables from large genome-wide association studies (GWAS) of schizophrenia as exposure, to identify the causal association of schizophrenia with mixed fractures, fractures at different body sites (including skull and facial bones, shoulder and upper arm, wrist and hand, and femur) and BMDs of forearm (FA), femoral neck (FN), lumbar spine (LS) and estimated BMD (eBMD). Multivariable Mendelian randomization (MVMR) analysis was performed to minimize the confounding effect of body mass index (BMI).

RESULTS

Result from inverse variance weighting (IVW) method provided evidence schizophrenia increased the risk of fractures of skull and facial bones [odds ratio (OR) = 1.0006, 95% confidence interval (CI): 1.0003 to 1.0010] and femur [OR =1.0007, 95% CI: 1.0003 to 1.0011], whereas, decreased the level of eBMD [β (95%CI): -0.013 (-0.021, -0.004)]. These causal effects still existed after adjusting for BMI. Sensitivity analyses showed similar results. However, no causal effect of schizophrenia on fracture or BMD in other parts was detected.

CONCLUSION

The current finding confirmed that schizophrenia was causally associated with the fractures of skull, face and femur as well as eBMD, which might remind psychiatrists to pay close attention to the fracture risk in schizophrenic patients when formulating their treatment strategies.

Risk factors for osteoporosis in chronic schizophrenia on long-term treatment with antipsychotics: a cross-sectional study

BACKGROUND

Little is known about the laboratory variable risks with bone mineral density (BMD) in patients with schizophrenia. This study was designed to fully investigate the related risk factors for decreased BMD in schizophrenia, as well as evaluate the gender difference of BMD.

METHOD

The BMD of the forearm of 211 patients (males/females = 140/71) who met the diagnostic criteria for DSM-5 schizophrenia was measured by dual-energy X-ray absorptiometry. Basic demographic information, clinical assessments, and laboratory variables (regarding nutrition, hormones, metabolism, and inflammatory markers) were comprehensively collected.

RESULTS

Among 211 subjects, seventy-four (35%) patients had low BMD. Males had a significantly lower BMD T-score than females (P = 0.002). Multiple regression analyses showed that the independent risks with low BMD were lower folate, glycosylated hemoglobin levels, higher age, serum ferritin, and follicle-stimulating hormone (FSH) levels. In female patients, the BMD was mainly associated with age and serum hormones (FSH and testosterone), while the BMD of male patients was primarily related to age, microelements (serum ferritin and 25-OH-VD), and parathyroid hormone.

CONCLUSION

Our study found several meaningful correlations between osteoporosis and schizophrenia, especially regarding laboratory measures, which may provide new clues to identifying or preventing osteoporosis in clinical patients.

Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital

Objectives

Falls in elderly patients treated in general hospitals have already been the focus of several studies. Research within psychiatric settings, however, remains limited, despite the fact that this population has a number of characteristics that could increase the fall risk. The aim of this retrospective study was to estimate the prevalence of falling in patients with a psychiatric hospital setting.

Methods

A retrospective descriptive chart review of falls registered in the period July 1, 2013 until June 30, 2019 in a Belgian University Psychiatric Hospital was conducted. Data were collected from the "patient related incident report and management system" (PiMS) of the hospital. All registered falls of all hospitalized patients were included in the study.

Results

During the 6-year study period an incidence of 4.4 falls per 1,000 patient days was found. Only 0.5% of the falls resulted in severe injury and none of these falls were fatal. Eighty percent of falls involved a patient over the age of 65. Only 25.0% of the elderly patients suffered physical consequences, while injuries were present in 31.4% of adults and 68.2% of young patients. The two most common causes of a fall were the health status (63.3%) and the behavior (55.1%) of the patient.

Conclusion

The estimated prevalence of falls in our study was generally in line with the rates found in literature on falls in psychiatric settings. Falls in psychiatric settings occur both in younger and older patients, suggesting that all age categories deserve sufficient attention in fall prevention policies. However, more research is necessary to improve fall prevention policies.

Metabolites of Gut Microbiota and Possible Implication in Development of Diabetes Mellitus

Diabetes mellitus is characterized by having a disorder of glucose metabolism. The types of diabetes mellitus include type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes mellitus, and other specific types of diabetes mellitus. Many risk factors contribute to diabetes mellitus mainly including genetics, environment, obesity, and diet. In the recent years, gut microbiota has been shown to be linked to the development of diabetes. It has been reported that the gut microbiota composition of diabetic patients is different from that of healthy people. Although the mechanism behind the abnormality remains to be explored, most hypotheses focus on the inflammation response and leaky gut in relation to the changes in production of endotoxins and metabolites derived from the intestinal flora. Consequently, the above-mentioned abnormalities trigger a series of metabolic changes, gradually leading to development of hyperglycemia, insulin resistance, and diabetes. This review is (i) to summarize the differences in gut microbiota between diabetic patients and healthy people, (ii) to discuss the underlying mechanism(s) by which how lipopolysaccharide, diet, and metabolites of the gut microbiota affect diabetes, and (iii) to provide a new insight in the prevention and treatment of diabetes.

Antidepressants and Vertebral and Hip Risk Fracture: An Updated Systematic Review and Meta-Analysis

Although antidepressant drugs appear to play an active role in increasing fracture risk, their weight is still unclear. We conducted a PRISMA compliant systematic review and meta-analysis through PubMed/Scopus/Cochrane libraries and registered with PROSPERO (registration number CRD42021254006) to investigate the relationship between antidepressant drugs categories, including SSRIs, SNRIs, and TCAs, and the risk of hip and vertebral fractures. After screening 3122 items, we finally found 26 papers for qualitative analysis and 11 for quantitative synthesis. A total of 15,209,542 adult and elderly patients were identified, with a mean follow-up of 51 months and a major prevalence of women. We identified results largely for SSRIs, with only a small amount of data for SNRIs, TCAs, and NaSSA. No data were found among the most recent categories of antidepressants, such as vortioxetine and esketamine. All included studies reported hip fractures, while three of them also included vertebral fractures. Overall, we observed a significant effect of SSRIs on fracture risk with a mean effect of 0.98 (95% CI = 0.75–1.20). This meta-analysis reveals that the use of SSRIs increases the risk of fractures. Clinicians’ awareness in antidepressant prescription should optimize their potential while reducing this risk.