Risk of hip fracture in patients with a history of schizophrenia

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.

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

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).

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.

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.