Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-28T06:21:11.440Z Has data issue: false hasContentIssue false
  • English
  • Français

Screening for osteoporosis: a survey of older psychiatric inpatients at a tertiary referral centre

Published online by Cambridge University Press:  06 October 2008

Brendon Stubbs ,
Enrique Zapata-Bravo  and
Camilla Haw
Brendon Stubbs
Affiliation:
St Andrew's Hospital, Northampton, U.K.
Enrique Zapata-Bravo
Affiliation:
St Andrew's Hospital, Northampton, U.K.
Camilla Haw*
Affiliation:
St Andrew's Hospital, Northampton, U.K.
*
Correspondence should be addressed to: Dr. Camilla Haw, Consultant Psychiatrist, St. Andrew's Hospital, Billing Road, Northampton, NN1 5DG, U.K. Phone: +44 604 616186; Fax: +44 604 616177. Email: chaw@standrew.co.uk.
Get access

Abstract

Background: Osteoporosis causes much morbidity and mortality among elderly people. Older inpatients with severe mental illness may be at particular risk of osteoporosis because of factors including immobility, vitamin D deficiency and psychotropic medication.

Method: We screened predominantly older inpatients with severe mental illness for osteoporosis using a peripheral DEXA scanner. Associations were examined between patient variables and osteoporosis as detected by DEXA scan, Z-scores and history of fragility fractures. Patients were followed up to see how many subsequently received drug treatment for osteoporosis. Patient acceptability of the scanning technique was also assessed.

Results: It was possible to scan 72/89 (81%) of patients. Mean T-score was −2.79 (SD 1.50) and mean Z-score −0.76 (SD 1.34). Forty-two (58%) patients had osteoporosis and 23 (32%) osteopenia. Twelve (17%) patients with a history of fragility fractures had osteoporosis on DEXA scan. A scan suggestive of osteoporosis and a history of fragility fractures were both associated with age of 75 years and over and thoracic kyphosis. Low Z-scores were associated with longer hospital stay and osteoporosis-predisposing drugs. Patient acceptability of scanning was high. At follow-up, only 7/16 (44%) patients were suitable for central scanning and 9/40 (23%) for bisphosphonates.

Conclusion: Older institutional patients with severe mental illness are likely to be at high risk of developing osteoporosis. Peripheral DEXA scanning is acceptable to these patients and identifies those at high risk of fractures. Some behaviorally disturbed patients are not suitable for central scans or for some osteoporosis drug treatments.

Keywords

osteoporosisosteopeniascreeningDEXA scanrisk factorsmental illnessolder adultsbisphosphonates
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 180 - 186
Copyright
Copyright © International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aspray, T. J., Francis, R. M., Thompson, A., Quilliam, S. J., Rawlings, D. J. and Tyrer, S. P. (1998). Comparison of ultrasound measurements at the heel between adults with mental retardation and control subjects. Bone, 22, 665–668.CrossRefGoogle ScholarPubMed
Aspray, T. J., Stevenson, P., Abdy, S. E., Rawlings, D. J., Holland, T., and Francis, R. M. (2006). Low bone mineral density measurements in care home residents – a treatable cause of fractures. Age and Ageing, 35, 37–41.Google Scholar
Blake, G. M., Patel, R., and Fogelman, I. (1998). Peripheral or axial bone density measurements? Journal of Clinical Densitometry, 1, 55–63.Google Scholar
Black, D. M. et al. (2007). Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. New England Journal of Medicine, 356, 1809–1822.CrossRefGoogle ScholarPubMed
Boonen, S., Vanderschueren, D., Haentjens, P. and Lips, P. (2006). Calcium and vitamin D in the prevention and treatment of osteoporosis – a clinical update. Journal of Internal Medicine, 259, 539–552.CrossRefGoogle ScholarPubMed
Center, J. R., Nguyen, T. V., Schneider, D., Sambrook, P. N. and Eisman, J. A. (1999). Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet, 353, 878–882.Google Scholar
Chrischilles, E. A., Butler, C. D., Davis, C. S. and Wallace, R. B. (1991). A model of lifetime osteoporosis impact. Archives of Internal Medicine, 151, 2026–2032.Google Scholar
Cummings, S. R. et al. (1995). Risk factors for hip fracture in white women. New England Journal of Medicine, 332, 767–773.Google Scholar
Dolan, P. and Torgerson, D. J. (1998). The cost of treating osteoporotic fractures in the UK female population. Osteoporosis International, 8, 611–617.CrossRefGoogle ScholarPubMed
Duque, G. et al. (2006). To treat or not to treat, that is the question. Proceedings of the Quebec Symposium for the treatment of osteoporosis in long-term care institutions, Saint-Hyacinthe, Quebec, November 5, 2004. American Medical Directors Association, 7, 435–441.CrossRefGoogle ScholarPubMed
Ensrud, K. E. et al. (1997) Correlates of kyphosis in older women. The Fracture Intervention Trial Research Group. Journal of the American Geriatrics Society, 45, 682–687.CrossRefGoogle ScholarPubMed
Holt, G. et al. (2002). Prevalence of osteoporotic bone mineral density at the hip in Britain differs substantially from the US over 50 years of age: implications for clinical densitometry. British Journal of Radiology, 75, 736–742.CrossRefGoogle ScholarPubMed
Johnell, O. (1996). Advances in osteoporosis: better identification of risk factors can reduce morbidity and mortality. Journal of Internal Medicine, 239, 299–304.CrossRefGoogle ScholarPubMed
Juby, A. G. (2004). The use of calcaneal ultrasound evaluation of bone mineral density in cognitively impaired seniors. JAMA, 5, 377–381.Google ScholarPubMed
Kanis, J. A., Johnell, O., Oden, H. and McCloskey, E. (2008). FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis International, 19, 385–397.Google Scholar
Keen, R. (2007). Osteoporosis: strategies for prevention and management. Best Practice and Research in Clinical Rheumatology, 21, 109–122.CrossRefGoogle ScholarPubMed
Kirk, J. K., Nichols, M. and Spangler, J. G. (2002). Use of peripheral Dexa measurement for osteoporosis screening. Family Medicine, 34, 201–205.Google Scholar
Melton, L. J. et al. (2005). Osteoporosis assessment by whole body vs. site specific DXA. Osteoporosis International, 16, 1558–1564.CrossRefGoogle ScholarPubMed
Meyer, J. M. and Lehman, D. (2006). Bone mineral density in male schizophrenic patients: a review. Annals of Clinical Psychiatry, 18, 43–48.CrossRefGoogle Scholar
Misra, M., Papakostas, G. I. and Klibanski, A. (2004). Effects of psychiatric disorders and psychotropic medications on prolactin and bone metabolism. Journal of Clinical Psychiatry, 65, 1607–1618.Google Scholar
Moayyeri, A., Soltani, A., Tabri, N. K., Sadatsafavi, M., Hossein-neghad, A. and Larijani, B. (2005). Discordance in diagnosis of osteoporosis using spine and hip bone densitometry. BMC Endocrine Disorders, 5, 3.Google Scholar
National Institute for Health and Clinical Excellence (2005). Osteoporosis – Secondary Prevention: The Clinical Effectiveness and Cost Effectiveness of Technologies for the Secondary Prevention of Osteoporotic Fractures in Postmenopausal Women. Available at: www.nice.org.uk/guidance/TA87. Last accessed 29 June 2008.Google Scholar
SPSS Inc. (2006). SPSS for Windows Release 14.0.2. Chicago: SPSS Inc.Google Scholar
Tyler, C. V., Snyder, C. W. and Zyzanski, S. (2000). Screening for osteoporosis in community-dwelling adults with mental retardation. Mental Retardation, 38, 316–321.2.0.CO;2>CrossRefGoogle ScholarPubMed
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.Google Scholar
WHO (1994). Assessment of Fracture Risk and its Application to Screening for Osteoporosis for Postmenopausal Osteoporosis. Technical Report Series 843 Geneva: World Health Organization.Google Scholar
Wright, R. M. (2007). Use of osteoporosis medications in older nursing facility residents. American Medical Directors Association, 8, 453–457.Google Scholar