Treatment for osteoporosis and fragility fractures in older people with SMI

Osteoporosis is a condition where bones become weaker and people are prone to fractures (broken bones). Osteoporosis is characterised by low bone density (strength and thickness of bones). Fragility fractures result from low-level injuries that would not cause a fracture in a person with healthy bones, and they are usually due to osteoporosis. Fragility fractures can affect the hip, back, pelvis, wrist, shoulder, and ribs. Osteoporosis leads to over 300,000 fragility fractures needing hospital treatment in the UK each year.

Severe mental illness (SMI) (including schizophrenia, bipolar disorder, other psychoses) is associated with increased risk of dying at a younger age, reduced quality of life and health service costs. Previous research has shown that schizophrenia is associated with low bone density and increased risk of fractures, although it is unclear if this is due to medication side effects, lifestyle factors or both. We already know that SMI can be associated with physical inactivity, poor nutrition, smoking, alcohol, and low vitamin D levels, which can all contribute to lower bone density, osteoporosis and an increased fracture risk. Moreover, osteoporosis in the general population frequently goes undetected, and people with SMI may face additional barriers in seeking medical advice about their health.

The proposed study will use UK primary care data to explore how well osteoporosis is being treated in people with SMI aged 50 years and above compared to the general population, whilst accounting for age, sex, and social deprivation. We will look at whether there is a difference in prescriptions issued for medications which are used to treat osteoporosis in the presence of SMI. If such a difference exists, we will investigate if it is influenced by deprivation, and by the presence of other long-term conditions that could affect GPs’ decisions about medication prescription.

We will also examine how long it takes on average for a person that has suffered a fragility fracture: a) to be screened for osteoporosis if they are 50 years and above, and b) to be prescribed osteoporosis medication if they are 75 years and above. We will compare that time lag between people with SMI and the general population to see if there are any delays or inequalities in treatment and thus in prevention of further fractures.

The results of this study will inform us about how we can improve the diagnosis and treatment of osteoporosis and fragility fractures in people with SMI and help prevent fractures from happening.

This topic has been highlighted as important in our discussion with members of the public with lived experience of osteoporosis or SMI. We will include lay members in our research to discuss the interpretation of findings and help us share the results with a wider audience.

Amount Awarded: £54,180