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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: [email protected].
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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

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