Women who suffer from major mood disorders and those who experience both psychosis and a substance use disorder (SUD) have a significantly increased risk for osteoporosis, research shows.
“People with schizophrenia are considered a high-risk group for developing bone loss and osteoporosis, due in part to the illness itself and to multiple associated risk factors such as poor diet, low exercise, early menopause, and antipsychotic-associated hyperprolactinemia,” said researcher Deanna L. Kelly, Pharm.D., an associate professor of psychiatry at the University of Maryland School of Medicine.
Hyperprolactinemia is an unusually high level of of the hormone prolactin in the blood.
“There is also evidence that osteoporosis and bone loss is greater in people who are smokers and who are substance abusing, both common in persons with psychotic disorders,” Kelly and her co-authors noted.
The team analyzed data from a Medicaid administrative database in order to investigate the occurrence of and frequency of screening for osteoporosis among women with psychotic disorders, SUDs, and nonpsychotic major mood disorders.
Of the 18,953 women, ages 50-64 years, 2143 (11.3 percent) had been diagnosed with psychosis, 704 (3.7 percent) had a mood disorder, and 1366 (7.2 percent) had SUD. The rest acted as a control group. A total of 6.7 percent of the women had osteoporosis at the time of the study, but only 4 percent of those without osteoporosis received screening.
As for being screened for osteoporosis, researchers found no significant difference in rates among women with psychosis, major mood disorders, and the control group. Those with a SUD, however, were a significant 39 percent less likely to receive screening compared to controls.
“We could not determine whether this reduction in screening occurs because clinicians fail to recommend the test to this population, because patients fail to follow-up on that recommendation, or due to other factors,” said the researchers.
The final results show that women with a major mood disorder and also those in the oldest age group (55-64 years) who were diagnosed with both SUD and psychosis were a significant 1.4 and 6.4 times more likely, respectively, to have osteoporosis than controls.
In contrast, women with only psychosis or only an SUD had a similar osteoporosis prevalence to the control group.
“Accordingly, it appears that efforts should be made to increase osteoporosis prevention and treatment in those with substance abuse problems and especially in those who also have comorbid psychosis,” wrote Kelly and co-authors in the journal Osteoporosis International.
“The higher rates of diagnosed osteoporosis among older women with major mood disorders indicate that this group, also, may require more extensive screening,” they said.