Lithium use and the risk of fractures

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A recent study reported a decreased risk of fractures among lithium users. We conducted a case–control study within the UK General Practice Research Database, comparing never, ever, current, recent and past lithium use in 231,778 fracture cases to matched controls. In addition, the risk of fractures was assessed in relation to cumulative duration of use and time since discontinuation.

Current use of lithium was associated with a decreased risk of fractures (adjusted odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.64–0.88), which did not vary with cumulative duration of use. Among past users an increased risk of fractures was observed (adjusted OR = 1.35, 95% CI = 1.01–1.79), increasing with time since discontinuation. Our results support the role of the underlying mental disorders in the aetiology of fractures and do not support a pharmacological effect of lithium based on lack of an association with cumulative duration of use.

Keywords: Fractures; Lithium; Mania; Depression

Ingeborg Wilting, Frank de Vries, Brahm M.K.S. Thio, Cyrus Cooper, Eibert R. Heerdink, Hubert G.M. Leufkens, Willem A. Nolen, Antoine C.G. Egberts and Tjeerd P. van Staa

Utrecht University, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht, The Netherlands
Department of Clinical Pharmacy, TweeSteden hospital and St Elisabeth Hospital, Tilburg, The Netherlands
Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England, UK
Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
General Practice Research Database, Medicines and Healthcare products Regulatory Agency, London, England, UK
Received 18 October 2006; revised 6 December 2006; accepted 13 December 2006.  Available online 21 December 2006.

Corresponding author. Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80.082, 3508 TB, Utrecht, The Netherlands. Fax: +31 30 2539166.

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