title: Schizophrenia and the risk of fractures: a systematic review and comparative meta-analysis.
abstract: BACKGROUND
  People with schizophrenia experience increased rates of osteoporosis and may be at heightened risk of fractures. We conducted a systematic review and meta-analysis to investigate fractures among people with schizophrenia compared to people without mental illness.
  
  
  METHODS
  We systematically searched major electronic databases from inception until October 2014. Articles were included that reported the number of fractures in people with schizophrenia and a control group. Two independent authors conducted searches, completed methodological assessment and extracted data. Data were narratively synthesized, and a random-effects incidence rate ratio (IRR) meta-analysis was performed.
  
  
  RESULTS
  Eight studies were included encompassing 48,384 people with schizophrenia (49.9-75.2 years, 41%-100% female) and 3,945,783 controls. The pooled adjusted rate of fractures per 1000 person-years was 5.54 [95% confidence interval (CI)=4.92-5.57] in people with schizophrenia and 3.48 (95% CI=3.39-3.64) in control participants. The comparative meta-analysis showed that people with schizophrenia experience an increased rate of fractures compared to control participants (IRR 1.72, 95% CI=1.24-2.39, I2=49%; n=168,914). There were insufficient data to conduct moderation analysis, but the narrative review consistently highlighted that antipsychotic medication was an important risk factor for fractures.
  
  
  CONCLUSIONS
  People with schizophrenia are at significantly increased risk of fractures. Future research is required to understand the mechanisms and should seek to validate fracture prediction algorithms used in the general population. Importantly, there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls-prevention strategies.
authors: Education and Health, University of Greenwich, Southwood Site Avery Hill Road Eltham, London SE9 2UG, UK. Electronic address: b.stubbs@greenwich.ac.uk.
authors: Brendon
authors: B
authors: Stubbs
authors: National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
authors: Fiona
authors: F
authors: Gaughran
authors: Department of Psycho-oncology, Leicester General Hospital, Leicestershire Partnership Trust, Leicester, UK.
authors: Alex J
authors: AJ
authors: Mitchell
authors: University Psychiatric Centre KU Leuven, Kortenberg, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium.
authors: Marc
authors: M
authors: De Hert
authors: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
authors: Ross
authors: R
authors: Farmer
authors: Department of Physiotherapy, University of Birmingham, Birmingham, B15 2TT, UK.
authors: Andrew
authors: A
authors: Soundy
authors: Musculoskeletal Division, The George Institute for Global Health and School of Public Health, University of Sydney, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia.
authors: Simon
authors: S
authors: Rosenbaum
authors: University Psychiatric Centre KU Leuven, Kortenberg, KU Leuven Departement of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium.
authors: Davy
authors: D
authors: Vancampfort
mesh_terms: D015897:Comorbidity; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D012559:Schizophrenia / Q000453:epidemiology*
keywords: Fracture; Fragility fracture; Osteoporosis; Psychosis; Schizophrenia