A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia


To assess the prevalence and moderators of low bone mass, osteopenia and osteoporosis in schizophrenia patients.

Major electronic databases were searched from inception till December 2013 for studies reporting the prevalence of low bone mass (osteopenia + osteoporosis = primary outcome), osteopenia or osteoporosis in schizophrenia patients. Two independent authors completed methodological appraisal and extracted data. A random effects meta-analysis was utilized.

Nineteen studies were included (n = 3038 with schizophrenia; 59.2% male; age 24.5–58.9 years). The overall prevalence of low bone mass was 51.7% (95% CI = 43.1–60.3%); 40.0% (CI = 34.7–45.4%) had osteopenia and 13.2% (CI = 7.8–21.6%) had osteoporosis. Compared with controls, schizophrenia patients had significantly increased risk of low bone mass (OR = 1.9, CI = 1.30–2.77, P < 0.001, n = 1872) and osteoporosis (OR = 2.86, CI = 1.27–6.42, P = 0.01, n = 1824), but not osteopenia (OR = 1.33, CI = 0.934–1.90, P = 0.1, n = 1862). In an exploratory regression analysis, older age (P = 0.004) moderated low bone mass, while older age (P < 0.0001) and male sex (P < 0.0001) moderated osteoporosis. The subgroup analyses demonstrated high heterogeneity, but low bone mass was less prevalent in North America (35.5%, CI = 26.6–45.2%) than Europe (53.6%, CI = 38.0–68.5%) and Asia (58.4%, CI = 48.4–67.7%), and in mixed in-/out-patients (32.9%, CI = 49.6–70.1%) vs. in-patients (60.3%, CI = 49.6–70.1%).

Reduced bone mass (especially osteoporosis) is significantly more common in people with schizophrenia than controls.


I have been told my prolactin which can cause osteopenia/osteoporosis is high but luckily a scan revealed my bones were ok.


Wonderful. Just wonderful.

What do they attribute the low bone mass to? Poor eating habits? Meds? Dehydration? Smoking?

I woke up with a broken back in January, and since then I’ve had a bone scan showing I have osteoporosis. I also have schizophrenia.

Exercise is supposed to be a good idea for me, as well as getting supplements of the right kind. Also, I have stopped smoking.

Like, how am I going to talk myself into exercise? I just stopped at the super market and parked my car a long way from the door. But like, big wuff!

Incidentally, the broken back hurt a lot!


Quite a lot is attributed to meds and the effects of high prolactin levels. However this article from 2007 Osteoporosis, Schizophrenia and Antipsychotics | CNS Drugs says:

An accelerated decrease in bone mineral density (BMD) in patients with schizophrenia may be disease related or drug induced. A drug-induced decrease in BMD has been attributed mostly to hyperprolactinaemia and its consequences. However, as demonstrated in this review, decreased BMD and osteoporosis are multifactorial processes, and abnormal bone structure and functions are not limited to BMD. Multiple dynamic processes may lead to impairment of bone homeostasis and eventually to bone abnormalities. Many of these processes may be abnormal in treated as well as untreated patients with schizophrenia.

Also poor diet with low calcium and vitamin D etc has been mentioned as a cause for increased osteopenia/osteoporosis in schizophrenia.

Wow. Thanks for the post firemonkey!

I have osteoporosis, and I have schizophjrenia.