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Devine M, Ma C, Tian J, Antony B, Cicuttini F, Jones G, Pan F. Association of Pain Phenotypes with Risk of Falls and Incident Fractures. Biomedicines 2022; 10:biomedicines10112924. [PMID: 36428490 PMCID: PMC9687743 DOI: 10.3390/biomedicines10112924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare whether falls risk score and incident fracture over 10.7 years were different among three previously identified pain phenotypes. Methods: Data on 915 participants (mean age 63 years) from a population-based cohort study were studied at baseline and follow-ups at 2.6, 5.1 and 10.7 years. Three pain phenotypes were previously identified using the latent class analysis: Class 1: high prevalence of emotional problems and low prevalence of structural damage; Class 2: high prevalence of structural damage and low prevalence of emotional problems; Class 3: low prevalence of emotional problems and low prevalence of structural damage. Fractures were self-reported and falls risk score was measured using the Physiological Profile Assessment. Generalized estimating equations model and linear mixed-effects model were used to compare differences in incident fractures and falls risk score over 10.7 years between pain phenotypes, respectively. Results: There were 3 new hip, 19 vertebral, and 121 non-vertebral fractures, and 138 any site fractures during 10.7-year follow-up. Compared with Class 3, Class 1 had a higher risk of vertebral (relative risk (RR) = 2.44, 95% CI: 1.22-4.91), non-vertebral fractures (RR = 1.20, 95% CI: 1.01-1.42), and any site fractures (RR = 1.24, 95% CI: 1.04-1.46) after controlling for covariates, bone mineral density and falls risk score. Class 2 had a higher risk of non-vertebral and any site fracture relative to those in Class 3 (non-vertebral: RR = 1.41, 95% CI: 1.17-1.71; any site: RR = 1.44, 95% CI: 1.20-1.73), but not vertebral fracture. Compared with Class 3, Class 1 had a higher falls risk score at baseline (β = 0.16, 95% CI: 0.09-0.23) and over 10.7-year (β = 0.03, 95% CI: 0.01-0.04). Conclusions: Class 1 and/or Class 2 had a higher risk of incident fractures and falls risk score than Class 3, highlighting that targeted preventive strategies for fractures and falls are needed in pain population.
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Affiliation(s)
- Maxim Devine
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Canchen Ma
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne 3181, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
- Correspondence: ; Tel.: +61-3-6226-7700; Fax: +61-3-6226-7704
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Ma R, Perera G, Romano E, Vancampfort D, Koyanagi A, Stewart R, Mueller C, Stubbs B. Predictors of falls and fractures leading to hospitalisation in 36 101 people with affective disorders: a large representative cohort study. BMJ Open 2022; 12:e055070. [PMID: 35277405 PMCID: PMC8919445 DOI: 10.1136/bmjopen-2021-055070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate predictors of falls and fractures leading to hospitalisation in people with affective disorders. DESIGN Cohort study. SETTING The South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register. PARTICIPANTS A large cohort of people with affective disorders (International Classification of Diseases- 10th version [ICD-10] codes F30-F34) diagnosed between January 2008 and March 2016 was assembled using data from the SLaM BRC Case Register. PRIMARY AND SECONDARY OUTCOME MEASURES Falls and fractures leading to hospitalisation were ascertained from linked national hospitalisation data. Multivariable Cox proportional hazards analyses were administrated to identify predictors of first falls and fractures. RESULTS Of 36 101 people with affective disorders (mean age 44.4 years, 60.2% female), 816 (incidence rate 9.91 per 1000 person-years) and 1117 (incidence rate 11.92 per 1000 person-years) experienced either a fall or fracture, respectively. In multivariable analyses, older age, analgesic use, increased physical illness burden, previous hospital admission due to certain comorbid physical illnesses and increase in attendances to accident and emergency services following diagnosis were significant risk factors for both falls and fractures. Having a history of falls was a strong risk factor for recurrent falls, and a previous fracture was also associated with future fractures. CONCLUSIONS Over a mean 5 years' follow-up, approximately 8% of people with affective disorders were hospitalised with a fall or fracture. Several similar factors were found to predict risk of falls and fracture, for example, older age, comorbid physical disorders and analgesic use. Routine screening for bone mineral density and fall prevention programmes should be considered for this clinical group.
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Affiliation(s)
- Ruimin Ma
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- University Psychiatric Centre KU Leuven, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Institució Catalana de Recerca i Estudis Avancats (ICREA), Barcelona, Spain
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, London, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, London, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, London, UK
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Chu YW, Chen WP, Yang AC, Tsai SJ, Hu LY, Lee SC, Lee YT, Shen CC. Hip, vertebral, and wrist fracture risks and schizophrenia: a nationwide longitudinal study. BMC Psychiatry 2022; 22:77. [PMID: 35105317 PMCID: PMC8805461 DOI: 10.1186/s12888-022-03723-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 01/21/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fractures are a great health issue associated with morbidity, quality of life, life span, and health care expenditure. Fractures are correlated with cardiovascular disease, type 2 diabetes mellitus, cerebrovascular disease, and some psychiatric disorders. However, representative national data are few, and longitudinal cohort studies on the association between schizophrenia and the subsequent fracture risk are scant. We designed a nationwide population-based cohort study to investigate the association of schizophrenia with hip, vertebral, and wrist fractures over a 10-year follow-up. METHODS Data of patients with schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification code 295) and matched over January 2000-December 2009) were extracted from Taiwan National Health Insurance Research Database. A Cox proportional-hazards regression model was constructed to calculate hazard ratios (HRs) for fractures between the schizophrenia and control cohorts. RESULTS Of 2028 people with schizophrenia (mean age: 36.3 years, 49.4% female), 89 (4.4%) reported newly diagnosed fractures-significantly higher than the proportion in the control population (257, 3.2%; P = 0.007). The incidences of hip (1.2%, P = 0.009) and vertebral (2.6%, P = 0.011) fractures were significantly higher in the schizophrenia cohort than in the control cohort. In Cox regression analysis, hip (adjusted HR: 1.78, 95% confidence interval [CI]: 1.08-2.93) and vertebral (adjusted HR: 1.40, 95% CI: 1.01-1.95) fracture risks were significantly higher in patients with schizophrenia. Furthermore, a sex-based subgroup analysis revealed that the risk of hip fracture remained significantly higher in female patients with schizophrenia (HR: 2.68, 95% CI: 1.32-5.44) than in female controls. On the other hand, there was no significant interaction between effects of sex and schizophrenia on the risk of fractures. CONCLUSIONS Over a 10-year follow-up, hip and vertebral fracture risks were higher in the people with schizophrenia than in the controls. The risk of fractures in patients with schizophrenia does not differ between female and male.
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Affiliation(s)
- Yu-Wen Chu
- grid.410764.00000 0004 0573 0731Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan ,grid.260539.b0000 0001 2059 7017Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan ,grid.265231.10000 0004 0532 1428Center for General Education, Tunghai University, Taichung, Taiwan
| | - Wen-Pin Chen
- grid.413878.10000 0004 0572 9327Department of Radiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Albert C. Yang
- grid.260539.b0000 0001 2059 7017Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan ,grid.38142.3c000000041936754XDivision of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA USA
| | - Shih-Jen Tsai
- grid.260539.b0000 0001 2059 7017Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan ,grid.278247.c0000 0004 0604 5314Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Hu
- grid.278247.c0000 0004 0604 5314Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ,grid.260539.b0000 0001 2059 7017Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan
| | - Shyh-Chyang Lee
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Yao-Tung Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan. .,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Center of dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei city, Taiwan.
| | - Cheng-Che Shen
- Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan. .,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, No. 600, Sec. 2, Shixian Rd., West District, Chiayi City, Taiwan. .,Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi City, Taiwan.
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Jeong JH, Jo MW, Chin DK, Son WS, Ock M, Lee JK. Validation of the European Quality of Life-5 Dimensions, 3-Level Version (EQ-5D-3L) in Patients With Osteoporotic Vertebral Fracture and Comparing Their Health-Related Quality of Life with That of the General Population in Korea. Korean J Neurotrauma 2022; 18:64-74. [PMID: 35557648 PMCID: PMC9064758 DOI: 10.13004/kjnt.2022.18.e19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This study examined the validity of the European Quality of Life-5 dimensions, 3-Level version (EQ-5D-3L) in patients with osteoporotic vertebral compression fractures (OVCF) and compared the health-related quality of life (HRQOL) of these patients with that of the general population in Korea. Methods Study participants completed several questionnaires, such as the EQ-5D-3L, 12-item short-form health survey version 2.0 (SF-12v2), Roland-Morris disability questionnaire (RMQ), and Pain Numeric Rating Scale (Pain NRS). Spearman’s correlation analyses of the questionnaire results were conducted to examine the discriminant and convergent validity of the EQ-5D-3L. Finally, EQ-5D-3L results from study participants were compared with those from the comparison group of the general population that were match-sampled according to age and sex from the 2013 Korean National Health and Nutritional Examination Survey. Results Spearman’s correlation coefficients between EQ-5D-3L and pain NRS, SF-12v2, and RMQ were statistically significant. The coefficients between the relevant dimensions, such as mobility in the EQ-5D-3L and physical functioning in the SF-12v2, were higher than those between irrelevant ones. Problems reported by study participants in each dimension of EQ-5D-3L showed statistically significant lower scores in pain NRS, PCS, and MCS from the SF-12v2 and RMQ scores. In comparison with the general population, the problems reported in the patient group were statistically higher than those reported by the general population. Conclusion This study showed that EQ-5D-3L will be useful for patients with OVCF in Korea because it could be valid. The HRQOL of patients with OVCF was very low in all dimensions of the EQ-5D-3L.
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Affiliation(s)
- Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Seung Son
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea
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Kelly RR, Sidles SJ, LaRue AC. Effects of Neurological Disorders on Bone Health. Front Psychol 2020; 11:612366. [PMID: 33424724 PMCID: PMC7793932 DOI: 10.3389/fpsyg.2020.612366] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how bone may affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment.
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Affiliation(s)
- Ryan R. Kelly
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Sara J. Sidles
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda C. LaRue
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
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Kim SY, Min C, Park B, Kim M, Choi HG. Evaluation of the increased risk of spine fracture in patients with mood disorder compared with matched controls: a longitudinal follow-up study using a national sample cohort in Korea. BMJ Open 2019; 9:e027581. [PMID: 31784429 PMCID: PMC6924799 DOI: 10.1136/bmjopen-2018-027581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the risk of spine fracture in patients with mood disorder using a nationwide cohort. DESIGN A longitudinal follow-up study. SETTING Claims data for the population ≥20 years of age were collected from 2002 to 2013 for the Korean National Health Insurance Service-National Sample Cohort. PARTICIPANTS A total of 60 140 individuals with mood disorder were matched with 240 560 individuals (control group) for age, sex, income, region of residence and osteoporosis. INTERVENTIONS In both the mood disorder and control groups, the history of spine fracture was evaluated. The International Classification of Diseases 10th Revision codes for mood disorder (F31-F39) and spine fracture (S220 and S320) were included. PRIMARY AND SECONDARY OUTCOME MEASURES The univariable and multivariable HRs and 95% CIs of spine fracture for patients with mood disorder were analysed using a stratified Cox proportional hazards model. Subgroup analyses were conducted according to the history of osteoporosis, age and sex. RESULTS Approximately 3.3% (2011/60 140) of patients in the mood disorder group and 2.8% (6795/240 560) of individuals in the control group had spine fracture (p<0.001). The mood disorder group demonstrated a higher adjusted HR for spine fracture than the control group (multivariable HR=1.10, 95% CI 1.04 to 1.15, p<0.001). The participants without osteoporosis showed a higher HR of mood disorder for spine fracture than the control participants (multivariable HR=1.25, 95% CI 1.14 to 1.37, p<0.001). According to age and sex, this result was consistent in subgroups of women aged 20-39 and 40-59 years and men aged ≥60 years. CONCLUSION The risk of spine fracture was increased in patients with mood disorder. The potential risk of spine fracture needs to be evaluated when managing patients with mood disorder.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Chuncheon, South Korea
| | - Bumjung Park
- Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, South Korea
| | - Miyoung Kim
- Laboratory Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Chuncheon, South Korea
- Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, South Korea
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Shi TT, Min M, Zhang Y, Sun CY, Liang MM, Sun YH. Depression and risk of hip fracture: a systematic review and meta-analysis of cohort studies. Osteoporos Int 2019; 30:1157-1165. [PMID: 30972449 DOI: 10.1007/s00198-019-04951-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
Recently published studies on the association between depression and hip fracture (HF) are inconsistent. Therefore, we performed this meta-analysis with the main aim to clarify the association between depression and HF, and also to identify possible susceptible groups. Relevant literature published until February 2019 was obtained and screened according to established inclusion criteria. Two researchers independently processed quality assessment and data extraction prior to the meta-analysis. Pooled hazard ratios (HRs) with 95%CI (confidence intervals) were calculated. To explore the sources of heterogeneity, subgroup analyses were performed based on study design, study region, NOS scores, follow-up duration, diagnostic criteria, sex, national income level, and adjustments (bone mineral density (BMD), antidepressant, calcium intake, and smoking). Ten studies with 13 estimates, involving 375,438 participants and 4576 HFs, were included. It was found that patients with depression had a higher risk of HF than non-depressed patients (HR = 1.21; 95%CI 1.11-1.31). Sensitivity analysis results show that the association is relatively stable. The studies that were not adjusted for confounders (e.g., antidepressant, BMD, calcium intake, and smoking) had higher overall HR compared to the studies that adjusted for the corresponding confounding factors. HFs are more likely to occur in European and male depression patients. This meta-analysis provided evidence of a modest positive association between depression and the risk of HFs, and the association is stronger in European and male patients. Implementation of practical measures to prevent and treat depression is of great public health significance.
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Affiliation(s)
- T T Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - M Min
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Y Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - C Y Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, 60657, Illinois, USA
| | - M M Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Y H Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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Association between depression and the risk for fracture: a meta-analysis and systematic review. BMC Psychiatry 2018; 18:336. [PMID: 30333001 PMCID: PMC6192066 DOI: 10.1186/s12888-018-1909-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several studies have suggested that depression is associated with an increased risk for fracture; however, the results are conflicting. This study aimed to conduct a meta-analysis of cohort studies assessing the association between depression and the risk for fracture. METHODS Relevant studies were identified by a search of Web of Science, PubMed, Embase, China National Knowledge Infrastructure and WanFang database to Feb 2018. Cohort studies on the relationship between depression and the risk for fracture in the general population were included in the meta-analysis. Data collection was in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the included studies was assessed using the Newcastle-Ottawa scale. Two independent investigators screened the abstracts and full texts of the studies, extracted data, and assessed the quality of the study. Either a fixed-effect or random-effects model was used to compute the pooled risk estimates when appropriate. RESULTS In total, 16 cohort studies with 25 independent reports that included 414,686 participants during a follow-up duration of 3-14 years were included in the analysis. The pooled hazard ratio (HR) for total fracture was 1.24 (95% confidence interval [CI]: 1.14-1.35; P < 0.001 for heterogeneity; random-effects model). In the subgroup analyses conducted in terms of study region, the pooled HR for the studies conducted in Europe was higher (HR: 1.76; 95% CI: 1.44-2.17; P = 0.792 for heterogeneity) than that in America and Asia, with a significant difference between the groups (P = 0.036). CONCLUSION The results of our meta-analysis suggest that depression is prospectively associated with a significantly increased risk for fracture, which may have substantial implications, both clinical and preventive.
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Houseknecht KL, Bouchard CC, Black CA. Elucidating the Mechanism(s) Underlying Antipsychotic and Antidepressant-Mediated Fractures. ACTA ACUST UNITED AC 2017; 1:9-13. [PMID: 31008454 PMCID: PMC6469345 DOI: 10.29245/2578-2959/2018/1.1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mood spectrum disorders and medications used to treat these disorders, such as atypical antipsychotic drugs (AA), are associated with metabolic and endocrine side effects including obesity, dyslipidemia, hyperglycemia and increased risk of fractures. Antidepressant medications, including selective serotonin reuptake inhibitors (SSRI), have also been reported to increase fracture risk in some patients. The pharmacology underlying the increased risk of fractures is currently unknown. Possible mechanisms include alternations in dopaminergic and/or serotonergic signaling pathways. As these medications distribute to the bone marrow as well as to the brain, it is possible that drug-induced fractures are due to both centrally mediated effects as well as direct effects on bone turnover. Given the growing patient population that is prescribed these medications for both on- and off-label indications, understanding the level of risk and the mechanisms underlying drug-induced fractures is important for informing both prescribing and patient monitoring practices.
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Affiliation(s)
- Karen L Houseknecht
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA.,College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
| | - C C Bouchard
- College of Osteopathic Medicine, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA
| | - C A Black
- College of Pharmacy, University of New England, 11 Hills Beach Road, Biddeford, ME 04005 USA
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