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Osteoporosis referral and treatment among people with severe mental illness: A ten-year data linkage study

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)94-102
Number of pages9
JournalJournal of psychiatric research
Early online date11 Jan 2022
Accepted/In press3 Jan 2022
E-pub ahead of print11 Jan 2022
PublishedMar 2022

Bibliographical note

Funding Information: CM and RS receive salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and RS is a NIHR Senior Investigator and is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding Information: BS is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health ResearchNational Institute for Health Research (NIHR). BS is part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. BS also holds active grants with the Medical Research Council (GCRF and multimorbidity calls) and Guys and St Thomas Charity (GSTT). BS also has been awarded a program NIHR Grant in relation to physical activity and severe mental illness (SPACES). BS is on the Editorial board of Ageing Research Reviews, Mental Health and Physical Activity, The Journal of Evidence Based Medicine and The Brazilian Journal of Psychiatry. The views expressed are those of the author(s) and not necessarily those of mentioned above, the NHS, the NIHR, the Department of Health and Social Care, the MRC, GSTT or any of the aforementioned. Funding Information: RS has received recent research funding from Roche, Janssen, GSK and Takeda. All other authors declare no conflict of interest. Publisher Copyright: © 2022

King's Authors


Introduction People with severe mental illness (SMI) are at increased risk of osteoporosis but minimal information is available on their treatment and referral. We investigated differences in these outcomes between patients with/without SMI in linked primary and specialist care data. Methods People with SMI aged 18+ at diagnosis with both primary and mental healthcare records between 1st May 2009 and 31st May 2019 from a south London catchment were matched 1:4 to randomly selected controls on gender, age and duration of primary care follow-up. Outcomes included prescription of osteoporosis medications and referrals for osteoporosis, analysed using multivariable logistic regression analyses. Results The study included 2269 people with SMI and 9069 matched non-SMI controls. People with SMI were more likely to have a recorded prescription of osteoporosis medications (odds ratio [OR] = 3.54, 95% confidence interval [CI] 2.87, 4.35) and be referred for osteoporosis (OR = 1.51, 95% CI 1.09, 2.08) within 2 years after the date of first SMI diagnosis after adjusting for ethnicity, deprivation and Charlson Comorbidity Index. Factors including older age (osteoporosis medications: OR = 1.04, 95% CI 1.03, 1.05; osteoporosis referral: OR = 1.05, 95% CI 1.04, 1.07) and being prescribed with Class A analgesics (osteoporosis medications: OR = 1.91, 95% CI 1.31, 2.77; osteoporosis referral: OR = 1.77, 95% CI 1.02, 3.07) are significant predictors for osteoporosis management pathways within SMI patients. Conclusion People with SMI are more frequently prescribed medications for osteoporosis and referred to osteoporosis screening than the general population. Given the many risk factors for osteoporosis in this group, this increased rate of referrals may well be warranted, and there is need to pay more attention to this at-risk group. Screening studies are needed to determine whether the rate of referral is proportional to the need.

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