title: A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia.
abstract: OBJECTIVE
  To assess the prevalence and moderators of low bone mass, osteopenia and osteoporosis in schizophrenia patients.
  
  
  METHODS
  Major electronic databases were searched from inception till December 2013 for studies reporting the prevalence of low bone mass (osteopenia + osteoporosis = primary outcome), osteopenia or osteoporosis in schizophrenia patients. Two independent authors completed methodological appraisal and extracted data. A random effects meta-analysis was utilized.
  
  
  RESULTS
  Nineteen studies were included (n = 3038 with schizophrenia; 59.2% male; age 24.5-58.9 years). The overall prevalence of low bone mass was 51.7% (95% CI = 43.1-60.3%); 40.0% (CI = 34.7-45.4%) had osteopenia and 13.2% (CI = 7.8-21.6%) had osteoporosis. Compared with controls, schizophrenia patients had significantly increased risk of low bone mass (OR = 1.9, CI = 1.30-2.77, P < 0.001, n = 1872) and osteoporosis (OR = 2.86, CI = 1.27-6.42, P = 0.01, n = 1824), but not osteopenia (OR = 1.33, CI = 0.934-1.90, P = 0.1, n = 1862). In an exploratory regression analysis, older age (P = 0.004) moderated low bone mass, while older age (P < 0.0001) and male sex (P < 0.0001) moderated osteoporosis. The subgroup analyses demonstrated high heterogeneity, but low bone mass was less prevalent in North America (35.5%, CI = 26.6-45.2%) than Europe (53.6%, CI = 38.0-68.5%) and Asia (58.4%, CI = 48.4-67.7%), and in mixed in-/out-patients (32.9%, CI = 49.6-70.1%) vs. in-patients (60.3%, CI = 49.6-70.1%).
  
  
  CONCLUSIONS
  Reduced bone mass (especially osteoporosis) is significantly more common in people with schizophrenia than controls.
authors.affiliation: School of Health and Social Care, University of Greenwich, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Stubbs
authors.forename: M
authors.initials: M
authors.lastname: De Hert
authors.forename: A A
authors.initials: AA
authors.lastname: Sepehry
authors.forename: C U
authors.initials: CU
authors.lastname: Correll
authors.forename: A J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: A
authors.initials: A
authors.lastname: Soundy
authors.forename: J
authors.initials: J
authors.lastname: Detraux
authors.forename: D
authors.initials: D
authors.lastname: Vancampfort
mesh_terms: D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D010024:Osteoporosis / Q000453:epidemiology*; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotics; bone mass; bone mineral density; hyperprolactinemia; meta-analysis; osteopenia; osteoporosis; physical health; schizophrenia; screening