Association of mental disorders and psychotropic medications with bone texture as measured with trabecular bone score

Hafizi, Sina; Lix, Lisa M.; Hans, Didier; Bolton, James M.; Leslie, William D.

Affiliations

¹University of Manitoba, Winnipeg, MB, Canada

²Center for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland

Abstract and keywords

Introduction: Mental disorders and psychotropic medications are known to increase the risk of osteoporosis and fractures. However, current evidence is mostly limited to studies that used bone mineral density (BMD), which does not provide information about the texture of bone tissue and can underestimate fracture risk.

Methods: We tested the association between bone texture, as measured with lumbar spine trabecular bone score (TBS), and both diagnosed mental disorders and psychotropic medication use in a large population-based BMD registry from Manitoba, Canada. General linear and logistic regression models were used to test the association of TBS with mental disorders (anxiety, depression, schizophrenia, and alcohol use disorder) and psychotropic medications use (selective serotonin reuptake inhibitors [SSRI], tricyclic antidepressants [TCA], other antidepressants, lithium, non‑lithium mood stabilizers, antipsychotics, and benzodiazepines), adjusted for comorbidities and confounding factors.

Results: The study population contained 45,716 women (mean age = 64.1, SD = 10.4), which included 21.1 % with diagnoses for mental disorders and 18.7 % using psychotropic medications. We observed significant negative covariate-adjusted effects on TBS from diagnosed alcohol use disorder (3.1 % reduction in TBS, p < 0.001) and exposure to SSRI (0.6 % reduction, p < 0.001), TCA (0.8 % reduction, p < 0.001), other antidepressants (0.8 % reduction, p < 0.001), and lithium (3 % reduction, p < 0.001). Logistic regression revealed that TBS in the lowest (versus highest) tertile was associated with alcohol use disorder (adjusted odds ratio [OR] = 2.87, 95 % confidence interval [CI]: 1.95, 4.21), exposure to SSRI (OR = 1.21; 95 % CI: 1.08, 1.35), TCA (OR = 1.18, 95 % confidence interval [CI]: 1.04, 1.35), other antidepressants (OR = 1.26; 95 % CI: 1.09, 1.45), and lithium (OR = 1.97; 95 % CI: 1.09, 3.57).

Conclusion: Our results suggest that alcohol use disorder, antidepressants, and lithium are associated with poorer bone texture in women. These findings add to the current literature on the link of bone pathology with mental disorders and psychotropic medications.

Keywords: Depression; Antidepressant; Dual-energy X-ray absorptiometry; Trabecular bone score; Alcohol use disorder; Psychotropic medication; Schizophrenia

Links

DOI: 10.1016/j.bone.2022.116565

PubMed: 36152942

WoS: 000864791800001

History

Received: 2022-04-12

Revised: 2022-08-24

Accepted: 2022-09-19

Online: 2022-09-22

Cited Works (4)

Year	Entry
2016	McCloskey EV, Odén A, Harvey NC, Leslie WD, Hans D, Johansson H, Barkmann R, Boutroy S, Brown J, Chapurlat R, Elders PJM, Fujita Y, Glüer C-C, Goltzman D, Iki M, Karlsson M, Kindmark A, Kotowicz M, Kurumatani N, Kwok T, Lamy O, Leung J, Lippuner K, Ljunggren Ö, Lorentzon M, Mellström D, Merlijn T, Oei L, Ohlsson C, Pasco JA, Rivadeneira F, Rosengren B, Sornay-Rendu E, Szulc P, Tamaki J, Kanis JA. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res. May 2016;31(5):940-948.
2015	Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD. Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 2: trabecular bone score. J Clin Densitom. July–September 2015;18(3):309-330.
2020	Agarwal S, Germosen C, Kil N, Bucovsky M, Colon I, Williams J, Shane E, Walker MD. Current anti-depressant use is associated with cortical bone deficits and reduced physical function in elderly women. Bone. November 2020;140:115552.
2005	Leslie WD, Caetano PA, MacWilliam LR, Finlayson GS. Construction and validation of a population-based bone densitometry database. J Clin Densitom. Spring, 2005;8(1):25-30.