Abstract：
Lithium is considered to be the most effective mood stabilizer for bipolar disorder. Evolving evidence suggested lithium can also regulate bone metabolism which may reduce the risk of fractures. While there are concerns about fractures for antipsychotics and mood stabilizing antiepileptics, very little is known about the overall risk of fractures associated with specific treatments. This study aimed to compare the risk of fractures in patients with bipolar disorder prescribed lithium, antipsychotics or mood stabilizing antiepileptics (valproate, lamotrigine, carbamazepine). Among 40,697 patients with bipolar disorder from 1993 to 2019 identified from a primary care electronic health record database in the UK, 13,385 were new users of mood stabilizing agents (lithium:2339; non-lithium: 11,046). Lithium was associated with a lower risk of fractures compared with non-lithium treatments (HR 0.66, 95 % CI 0.44-0.98). The results were similar when comparing lithium with prolactin raising and sparing antipsychotics, and individual antiepileptics. Lithium use may lower fracture risk, a benefit that is particularly relevant for patients with serious mental illness who are more prone to falls due to their behaviors. Our findings could help inform better treatment decisions for bipolar disorder, and lithium\'s potential to prevent fractures should be considered for patients at high risk of fractures.
摘要：
锂被认为是双相情感障碍最有效的情绪稳定剂。不断发展的证据表明，锂还可以调节骨代谢，从而降低骨折的风险。虽然人们担心抗精神病药和情绪稳定抗癫痫药的骨折，对与特定治疗相关的骨折总体风险知之甚少.这项研究旨在比较双相情感障碍患者的骨折风险，抗精神病药或情绪稳定抗癫痫药（丙戊酸盐，拉莫三嗪,卡马西平）。从英国的初级保健电子健康记录数据库中确定的1993年至2019年的40,697名双相情感障碍患者中，13,385是情绪稳定剂的新用户（锂：2339；非锂：11046）。与非锂治疗相比，锂与骨折风险较低相关（HR0.66，95％CI0.44-0.98）。将锂与催乳素升高和保留抗精神病药物进行比较时，结果相似，和个体抗癫痫药。使用锂可以降低骨折风险，这对于患有严重精神疾病的患者来说尤其重要，因为他们的行为更容易跌倒。我们的发现可能有助于为双相情感障碍提供更好的治疗决策，对于骨折风险高的患者，应考虑锂预防骨折的潜力。
