Association of Severe Mental Illness with Osteoporosis Referral and Medication Prescription

Pavankumar Kamat


February 01, 2022


  • Patients with severe mental illness (SMI) were more likely to be prescribed osteoporosis medications and had a higher referral rate for osteoporosis screening than the general population.

Why this matters

  • Findings highlight the need for more proactive measures and strategies to screen and treat osteoporosis in patients with SMI at a younger age along with greater awareness of the exacerbating effects of prolactin-raising anti-psychotic medications.

Study design

  • The study analysed data from primary and mental health care in a population-based electronic health record database linkage (2009-2019).

  • 2269 patients with SMI (age, >18 years) from south London were matched (1:4) with 9069 participants without SMI.

  • Main outcomes: prescription of osteoporosis medications and referrals for osteoporosis screening.

  • Funding: None disclosed.

Key results

  • Patients with SMI vs those without were more likely to be prescribed osteoporosis medications (adjusted OR [aOR] 3.54; 95% CI 2.87 to 4.35; P<0.001) and had a higher referral rate for osteoporosis screening (aOR 1.51; 95% CI 1.09 to 2.08; P=.01) within 2 years after the date of first SMI diagnosis.

  • In patients with SMI, factors associated with osteoporosis management were (aOR; 95% CI):

    • older age:

      • osteoporosis medications (1.04; 1.03 to 1.05); and

      • osteoporosis referrals (1.05; 1.04 to 1.07; P<0.001 for both).

    • being prescribed with Class A (non-opioid) analgesics:

      • osteoporosis medications (1.91; 1.31 to 2.77; P=0.001); and

      • osteoporosis referrals (1.77; 1.02 to 3.07; P=0.04).


  • The study was restricted to a single geographical area.

  • Risk of potential confounding.

Ma R, Romano E, Davis K, Stewart R, Ashworth M, Vancampfort D, Gaughran F, Stubbs B, Mueller C. Osteoporosis referral and treatment among people with severe mental illness: A ten-year data linkage study. J Psychiatr Res. 2022 Jan 06 [Epub ahead of print];147:94-102. doi: 10.1016/j.jpsychires.2022.01.005. PMID: 35030512 View abstract.


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