精神分裂症病患的骨折風險增加


  【24drs.com】March 2, 2010 (德國慕尼黑) — 根據發表於歐洲精神科協會第18屆歐洲精神病研討會中的資料,精神分裂症病患發生骨折的機會是一般人的兩倍以上。
  
  結果也顯示,約有四分之一的骨折包含多個部位,且男性的骨折多於女性。
  
  紐澤西East Orange私人開業內科醫師Shashi K. Agarwal向Medscape Psychiatry表示,重點在強調我們的結果是初步發現,我們正擴大研究,希望進一步闡述這類病患骨折發生率增加的原因。
  
  Agarwal醫師與共同作者、紐澤西Piscataway Rutgers大學生物醫學工程系學生Neil K. Agarwal訪問了115名因為與骨折相關之各種醫療情況而前往該診所就醫的病患。
  
  【提出多種可能原因】
  Agarwal醫師指出,個別的報告認為,精神分裂症病患的骨折風險可能比一般人高。
  
  此一觀察現象可能出於多種原因,包括骨質疏鬆與其他共病症、因為心理疾患引起的風險行為、步態不穩、認知能力降低、環境因素、營養不佳、長期過量抽菸、喝酒、移動力降低、精神病藥物的影響等。
  
  Agarwal醫師表示,他注意到他有許多精神分裂症病患有一些因為之前的骨折留下的疤痕或殘疾,因此進行了目前的研究,對一個內科醫師的病患之前的骨折事件進行綜合評估。
  
  研究對象年紀為19-81歲,整體而言,79名病患(68.7%)是男性,36人(31.3%)是女性,所有病患都有服用精神病藥物,且接受精神科醫師的照護,Agarwal醫師表示,我們相信,這些研究對象代表內科醫師診間的典型精神分裂症患者。
  
  【將近半數精神分裂症患者發生過骨折】
  結果顯示,51名病患(44%)有過骨折,38人(33%)是單一骨折病史,其他13人(11%)則是多次骨折病史。
  
  43例為肢體骨折,13例非肢體骨折。8名病患(61.5%)只有非肢體骨折,5名病患(38.5%)有非肢體骨折且有肢體骨折。
  
  43例肢體骨折中,27例(62.8%)上肢骨折,23人(53.5%)下肢骨折,7人(16.3%)同時有上肢和下肢骨折。
  
  Agarwal醫師觀察發現,研究對象曾有骨折的比率為44%,幾乎是一般人的骨折比率16%-18%的2.5倍。
  
  他指出,雖然醫學文獻似乎認為骨質疏鬆可能是引起精神分裂症患者骨折發生率增加的主因,但他強調,這不具說服力。
  
  他表示,我有點感到疑惑的是,骨質疏鬆一般傾向增加低影響度的骨折,這些通常發生在髖骨或脊椎,不過,我們的病患有顯著的肢體骨折,這是高影響性的骨折,因此,可能有其他機轉造成。
  
  他指出,研究對象的骨質減少和骨質疏鬆比率資料,以及泌乳激素值,將納入後續的分析中。
  
  Agarwal醫師表示,研究目標除了確認骨質疏鬆增加精神分裂症患者之骨折頻率的確定角色之外,也需探討各種介入方式的價值。
  
  他表示,需後續研究探討更均衡飲食的醫療介入、規律的可負荷運動、避免抽菸飲酒、增加曬太陽與服用維他命D補充品等,是否可以降低精神分裂症患者的骨折傾向。
  
  他指出,雖然這個是初步資料,但是他希望可以刺激此一領域的更多研究,且幫助預防這類通常照護不足者的傷害。
  
  紐約市、NYU Langone 醫學中心精神科教授Dolores Malaspina與Steckler向Medscape Psychiatry表示,此報告將提醒醫師,精神分裂症可能會有骨密度去礦質化以及較多的骨折。
  
  她指出,不幸的是,開業醫師有時候會忽視骨折,有部分可能是因為病患的病史不佳,也可能是因為病患對疼痛的敏感度降低,也可能沒有特殊症狀。
  
  她表示,抗精神病藥物引起的泌乳激素增加可能會造成此風險,不過,在未服用藥物的病患也有觀察到泌乳激素上升,其他風險因素包括抽菸過量、活動力不好、營養不佳。
  
  最後,她觀察發現,精神分裂症病患以及劇渴可能與骨質疏鬆和骨折特別有關。
  
  S. K. Agarwal醫師以及N. K. Agarwal和 Malaspina醫師皆宣告沒有相關財務關係。
  
  歐洲精神病協會第18屆歐洲精神病研討會:摘要374。發表於2010年2月28日。

Schizophrenics Have Increased Rate of Bone Fractures

By Jill Stein
Medscape Medical News

March 2, 2010 (Munich, Germany) — Schizophrenic patients sustain more than twice as many bone fractures as the general population, according to data released here at the European Psychiatric Association 18th European Congress of Psychiatry.

The results also showed that about a fourth of the fractures involved multiple sites and that males appeared to have more fractures than females.

“It is important to emphasize that our findings are preliminary, and we are expanding our study to hopefully further elucidate the cause of increased susceptibility to fractures in this population,” Shashi K. Agarwal, MD, an internist in private practice in East Orange, New Jersey, told Medscape Psychiatry.

Dr. Agarwal and his coauthor Neil K. Agarwal, a biomedical engineering student at Rutgers University in Piscataway, New Jersey, queried 115 consecutive patients who presented to their practice for a variety of medical conditions about prior fractures.

Dr. Shashi K. Agarwal and Neil K. Agarwal

Multiple Possible Causes Proposed

“Isolated reports suggest that schizophrenic patients may have a higher risk of bone fractures than the population at large,” Dr. Agarwal pointed out.

There may be multiple causes for this observation, including osteoporosis and other comorbidities, risky behavior because of the mental illness, unsteady gait, decreased cognition, environmental factors, malnutrition, long-term excessive smoking, alcohol, decreased mobility, and the effects of psychotropic drugs.

Dr. Agarwal said that he had noticed that many of his schizophrenic patients had exhibited scars or deformities resulting from prior fractures.

Accordingly, the present study was undertaken to permit a general assessment of previous bone fractures in an internist’s office.

Study participants ranged from 19 to 81 years of age. Overall, 79 patients (68.7%) were male and 36 (31.3%) were female. All patients were taking psychotropic drugs and under the care of a psychiatrist. “We believe our cohort represents a typical population of schizophrenics presenting to an internist’s office,” Dr. Agarwal said.

Prior Bone Fractures Found in Nearly Half of Schizophrenic Patients

Results showed that 51 patients (44%) reported a history of previous bone fractures. Thirty-eight patients with a history of bone fracture (33%) cited a history of single fractures, and the other 13 patients (11%) gave a history of multiple fractures.

Forty-three patients had extremity fractures and 13 had nonextremity fractures. Eight patients (61.5%) had only nonextremity fractures and 5 patients (38.5%) had nonextremity fractures in addition to extremity fractures.

Of the 43 extremity fractures, 27 (62.8%) involved fractures of the upper limbs, 23 (53.5%) involved fractures of the lower limbs, and 7 (16.3%) involved fractures of both the upper and lower limbs.

“The 44% rate of prior bone fractures in the study population is almost 2.5 times the 16% to 18% rate of bone fractures typically reported in the general population,” Dr. Agarwal observed.

He noted that although the medical literature seems to suggest that osteoporosis is probably the main cause of the increased rate of bone fractures in schizophrenic patients, he emphasized that he is not convinced.

“I am somewhat puzzled as osteoporosis would normally increase the tendency for low-impact bone fractures and these usually occur in the hips or vertebrae,” he said. “However, our patients had predominantly extremity fractures, which are generally high-impact fractures, thereby suggesting that other mechanisms may play a role.”

He added that data on the rates of osteopenia and osteoporosis in the study population, as well as prolactin levels, will be included in a later analysis.

Dr. Agarwal said that in addition to research aimed at identifying the precise role of osteoporosis in the increased frequency of bone fractures in the schizophrenic population, studies are also needed to examine the value of various interventions.

“Further study is necessary to see if medical intervention with a more balanced diet, regular weight-bearing exercise, avoidance of tobacco and alcohol, and increased exposure to sunlight and vitamin D supplementation would reduce this higher propensity toward fractures in schizophrenics,” he said.

He added that he hopes that his data, though preliminary, “will stimulate more work in this area and help prevent these injuries in this often underserved population.”

“This report should remind clinicians that bone density demineralization and an excess of fractures can accompany schizophrenia.” Dolores Malaspina, MD, professor and Steckler professor of psychiatry at NYU Langone Medical Center in New York City, told Medscape Psychiatry.

Unfortunately, fractures may sometimes be overlooked by practitioners, in part because patients may be poor historians, but also because patients often have reduced sensitivity to pain and may not have characteristic symptoms, she added.

An elevation in prolactin levels from antipsychotic medications may contribute to this risk, although elevated prolactin levels have also been observed in unmedicated patients, she said. Other risk factors include excessive tobacco exposure, inactivity, and poor nutrition.

Finally, she observed that patients with schizophrenia and polydipsia may be especially susceptible to osteoporosis and fractures.

Dr. S. K. Agarwal, Dr. N. K. Agarwal, and Dr. Malaspina have disclosed no relevant financial relationships.

European Psychiatric Association (EPA) 18th European Congress of Psychiatry: Abstract 374. Presented February 28, 2010.

    
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