Supplemental Digital Content Figure 1: Sample selection Nationally-representative random sample of all VHA patients in FY2002 [N = 100,000] NPR* registrants with BPD with VHA utilization data in FY2002 [N = 70,345] Exclude those with SMI diagnosis in FY2002 N = 4725 N = 95,275 Exclude those with BPD diagnosis in FY99 –01 N = 884 N = 94,391 N = 19,218 N = 30,455 Exclude those aged < 50 N = 75,173 N = 39,890 Exclude those with missing data on demographic characteristics N = 32,969 N = 6,500 N = 42,204 N = 33,390 N = 75,594 Exclude those with diagnosis of fracture, osteoporosis, osteomalacia, or osteopenia from FY99 to mid-FY02 N = 6,089 N = 69,505 Exclude those who died in first 6 months of FY2002 N = 867 N = 68,638 *NPR; National Psychosis Registry (NPR) of all VHA patients with serious mental illness (SMI) (ICD-9 code of schizophrenia, bipolar disorder, or schizoaffective disorder) enrolled beginning in 1988 Exclude those with epilepsy diagnosis FY99 - 01 N = 1,251 FINAL SAMPLE N = 67,387