Bipolar Disorder is a chronic, episodic illness estimated to affect approximately 2.4% of the population.  It is associated with significant personal, social and economic burden and both psychological and/or physiological comorbidities are common. Osteoporosis is one such possible comorbidity; a disease of bone that is asymptomatic until a fracture occurs. This systematic review attempts to capture, collate, assess and discuss the literature investigating the association between bipolar disorder and bone health. 

Articles that investigate the association between bipolar disorder and bone health in adults will be identified by systematically searching the Medline, PubMed, OVID and CINAHL databases. Two independent reviewers will determine eligibility of studies according to pre-determined criteria, and methodological quality will be assessed using a previously published methodological scoring system, which reflects cohort studies as the most optimal study design, followed by case-control studies, and finally, cross-sectional study designs. Each study will be ranked according to their total score(%), and deemed as having higher methodological quality if scored above the median. A meta-analysis will be conducted, using the Hunter-Schmidt approach and effect size will be corrected for measurement error whereby measurement error correction equals the effect size divided by the square root of r. If numerical syntheses are prevented due to statistical heterogeneity, a best evidence synthesis will be conducted to assess the level of evidence for associations between bipolar spectrum disorder and bone health. 

To our knowledge, this will be the first systematic review to identify and evaluate the existing evidence-base regarding associations between bipolar disorder and bone. The findings of this review will contribute to existing literature investigating other psychiatric disorders and bone health, and will also provide an evidence-base on which resource allocation and clinical and public health strategies aimed at reducing burden associated with both osteoporosis and bipolar disorder can be founded.