Risk of hip fracture in patients with a history of schizophrenia.
BACKGROUND
There is evidence of an association between decreased bone mineral density, schizophrenia, and prolactin-raising antipsychotic medication. However, it is not known whether this is clinically significant.


OBJECTIVE
To investigate whether patients with a history of schizophrenia are at increased risk of hip fracture.


METHODS
In a case-control study, we compared cases of 'hip fracture' on the General Practice Research Database (n=16,341) with matched controls (n=29,889).


RESULTS
Hip fracture was associated with schizophrenia (OR=1.73; 95% CI 1.32-2.28), and prolactin-raising antipsychotics (OR=2.6; 95% CI 2.43-2.78), in the univariate analysis. In the multivariate analysis, prolactin-raising antipsychotics were independently associated with hip fracture but schizophrenia was not. A significant interaction between gender and antipsychotics was foundinthe association with hip fracture (P=0.042); OR=2.12 (95% CI1.73-2.59) for men, OR=1.93 (95% CI1.78-2.10) for women.


CONCLUSIONS
The association between prolactin-raising antipsychotic medication and hip fracture may have serious implications for public health. Mental health service patients may require preventive measures including dietary and lifestyle advice.
Howard
Louise
L
Health Services Research Department, Institute of Psychiatry, King's College London SE5 8AF, UK. l.howard@iop.kcl.ac.uk
Kirkwood
Graham
G
Leese
Morven
M
D000058:Accidental Falls; D014150:Antipsychotic Agents / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects*; D016022:Case-Control Studies; D005260:Female; D006620:Hip Fractures / Q000139:chemically induced*; D006801:Humans; D008297:Male; D011388:Prolactin / Q000187:drug effects*; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy*
D014150:Antipsychotic Agents; D011388:Prolactin