Schizophrenia and the risk of fractures: a systematic review and comparative meta-analysis

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. Method: 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. Conclusion: 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