Osteoporosis screening and treatment in women with schizophrenia: A controlled study

Study Objective. As patients with a major psychiatric disorder such as schizophrenia generally are less likely to have their medical illnesses diagnosed and medically managed, we investigated whether osteoporosis screening, prevention management, and/or drug therapy (i.e., clinical services for osteoporosis) are provided consistently to both women with schizophrenia and those without the disease. Design. Retrospective medical record review. Setting. Three Midwest Veterans Affairs medical centers and clinics. Patients. Forty-six women aged 45 years or older who had schizophrenia and 46 female control subjects who were frequency matched on age. Measurements and Main Results. Twelve months of progress notes were reviewed for osteoporosis clinical services. In addition, smoking status, smoking cessation counseling, alcohol consumption, and fracture rates were compared between the groups. Overall, significantly fewer patients with schizophrenia (28 patients [61%]) received a clinical service for osteoporosis compared with the control group (37 patients [80%]). This difference was due to a significantly fewer number of patients with schizophrenia who received any osteoporosis agent (22 patients [48%]) compared with the control group (36 patients [78%]). Only 13 patients (28%) with schizophrenia received hormone replacement therapy compared with 25 control patients (54%). Conclusion. Women with schizophrenia in three Midwest Veterans Affairs medical centers did not receive the same level of osteoporosis care as that of age-matched control patients. This was primarily due to a lower utilization of osteoporosis agents, specifically hormone replacement therapy. Further research is necessary to determine the reason for this difference. Clinicians should be aware of medical management issues in patients with major psychiatric diagnoses and, specifically, osteoporosis care of women with schizophrenia.