Bipolar disorder and the risk of fracture: A nationwide population-based cohort study

Jian An Su, Bi Hua Cheng, Yin Cheng Huang, Chuan Pin Lee, Yao Hsu Yang, Mong Liang Lu, Chung Yao Hsu, Yena Lee, Roger S. McIntyre, Tzu Chin Lin, Vincent Chin-Hung Chen

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Background The co-primary aims are: 1) to compare the risk of fracture between adults with bipolar disorder and those without bipolar disorder; and 2) to assess whether lithium, anticonvulsants and antipsychotics reduce risk of fracture among individuals with bipolar disorder. Methods The analysis herein is a population-based retrospective cohort study, utilizing the National Health Insurance (NHI) medical claims data collected between 1997 and 2013 in Taiwan. We identified 3705 cases with incident diagnoses of bipolar disorder during study period and 37,050 matched controls without bipolar diagnoses. Incident diagnosis of fracture was operationalized as any bone fracture after the diagnosis of bipolar disorder or after the matched index date for controls. Results Bipolar patients had significantly higher risk of facture when compared to matched controls (17.6% versus 11.7%, respectively p<0.001). The hazard ratio (HR) was 1.33 (95% confidence interval [CI]=1.23–1.48, p<0.001) after adjusting for covariates. Persons with bipolar disorder and a prior history of psychiatric hospitalization were had higher risk for bone fracture than those without prior history of psychiatric hospitalization when compared to match controls. Higher cumulative dose of antipsychotics or mood stabilizers did not increase the risk of fracture. Limitations The diagnoses of bipolar disorder were not confirmed with structured clinical interview. Drug adherence, exact exposure dosage, smoking, lifestyle, nutrition and exercise habits were unable to be assessed in our dataset. Conclusions Bipolar disorder is associated with increased risk of fracture, and higher cumulative dose of mood stabilizers and antipsychotics did not further increase the risk of fracture.

Original languageEnglish
Pages (from-to)246-252
Number of pages7
JournalJournal of Affective Disorders
Publication statusPublished - Aug 15 2017


  • Anticonvulsants
  • Antipsychotics
  • Bipolar disorder
  • Fracture
  • Lithium
  • Mood stabilizers

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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