International Psychogeriatrics

Research Article

Screening for osteoporosis: a survey of older psychiatric inpatients at a tertiary referral centre

Brendon Stubbsa1, Enrique Zapata-Bravoa1 and Camilla Hawa1 c1

a1 St Andrew's Hospital, Northampton, U.K.

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.

(Received March 11 2008)

(Revised May 08 2008)

(Revised July 01 2008)

(Accepted July 03 2008)

(Online publication October 06 2008)

Correspondence:

c1 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: chaw@standrew.co.uk.