Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis

Abstract

It remains unclear if differences in bone mineral density (BMD) exist at different skeletal sites between people with schizophrenia and age- and sex-matched healthy controls (HCs). Major databases were searched from inception until February 2016 for studies measuring BMD using dual-energy X-ray absorptiometry (DXA) at any skeletal site in individuals with schizophrenia. Ten studies investigating 827 people with schizophrenia (55.4 % female, 33.8 ± 9.7 years) and 1379 HCs (58.7 % female, 34.7 ± 9.1 years) were included. People with schizophrenia had significantly reduced BMD at the lumbar spine (standardised mean difference adjusted for publication bias (SMD) = −0.950 (95 % CI = −1.23 to −0.66, fail-safe number = 825) and hip (SMD = −0.534, 95 % CI = −0.876 to −0.192, fail-safe number = 186). A higher proportion of hyperprolactinaemia (β = −0.0102, p < 0.0001) and smokers (β = −0.0099, p = 0.02) moderated a larger reduced BMD at the lumbar spine. Further research is required to investigate if low bone mass and fractures can be prevented in people with schizophrenia.