Association of Mental Disorders and Related Medication Use With Risk for Major Osteoporotic Fractures
Association of Mental Disorders and Related Medication Use With Risk for Major Osteoporotic Fractures
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DOI：
10.1001/jamapsychiatry.2017.0449
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发表时间：
2017-06-01
期刊：
影响因子：
25.8
通讯作者：
Leslie, William D.
中科院分区：
文献类型：
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作者：
Bolton, James M.;Morin, Suzanne N.;Leslie, William D.
骨质疏松性骨折是导致残疾、费用和死亡的主要原因。FRAX是一种用于评估普通人群骨折风险的工具。精神障碍和治疗精神障碍的药物对骨骼健康有不良影响，但是，迄今为止，还没有系统地研究精神障碍和精神药物的使用与骨质疏松性骨折的关系。目的：在常规临床实践中，研究精神障碍和精神药物的使用与骨质疏松性骨折风险的关系。使用来自马尼托巴骨密度项目数据库的数据，使用骨矿物质密度和风险因素计算FRAX评分，这些数据来自加拿大马尼托巴所有40岁或40岁以上的女性和男性，从1996年1月1日至2013年3月28日进行基线双能X射线吸收测定扫描。基于人口的卫生服务数据被用来确定在前3年的原发性精神障碍，精神药物的使用在前一年，和骨折事件。考克斯比例风险回归模型根据精神障碍和精神药物的使用估计了骨折的风险。数据分析时间为2013年11月25日至2016年10月15日。主要结局和指标：非创伤性主要股骨颈骨折（MOFs）和髋部骨折的发生率。（62 275名妇女和6 455名男子;平均年龄，64.2 [11.2]岁），在485 322人-年期间（中位数，6.7年）的观察，5750（8.4%）持续发生MOF，1579（2.3%）持续发生髋部骨折，8998（13.1%）死亡。在调整FRAX评分的分析中，抑郁与MOF相关（调整后的风险比[aHR]，1.39; 95%CI，1.27-1.51; P
IMPORTANCE Osteoporotic fractures are a leading cause of disability, costs, and mortality. FRAX is a tool used to assess fracture risk in the general population. Mental disorders and medications to treat them have been reported to adversely affect bone health, but, to date, they have not been systematically studied in relation to osteoporotic fractures.OBJECTIVE To examine the association of mental disorders and psychotropic medication use with osteoporotic fracture risk in routine clinical practice.DESIGN, SETTING, AND PARTICIPANTS In this population-based cohort study, bone mineral density and risk factors were used to calculate FRAX scores using data from the Manitoba Bone Density Program database of all women and men 40 years of age or older in Manitoba, Canada, referred for a baseline dual-energy x-ray absorptiometry scan from January 1, 1996, to March 28, 2013. Population-based health services data were used to identify primary mental disorders during the 3 prior years, psychotropic medication use during the prior year, and incident fractures. Cox proportional hazards regression models estimated the risk for incident fractures based on mental disorders and use of psychotropic medications. Data analysis was conducted from November 25, 2013, to October 15, 2016.MAIN OUTCOMES AND MEASURES Incident nontraumatic major osteoporotic fractures (MOFs) and hip fractures.RESULTS Of the 68 730 individuals (62 275 women and 6455 men; mean age, 64.2 [11.2] years) in the study, during 485 322 person-years (median, 6.7 years) of observation, 5750 (8.4%) sustained an incident MOF, 1579 (2.3%) sustained an incident hip fracture, and 8998 (13.1%) died. In analyses adjusted for FRAX score, depression was associated with MOF (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.27-1.51; P