Association between gonadal hormones and osteoporosis in schizophrenia patients undergoing risperidone monotherapy: a cross-sectional study

Abstract

Objective Patients with schizophrenia are at increased risk of osteoporosis. This study first determined the osteoporosis rate in patients with schizophrenia and then then explored the association between serum gonadal hormone levels and osteoporosis among these patients. Methods A total of 250 patients with schizophrenia and 288 healthy controls were recruited. Osteoporosis was defined by decreased bone mineral density (BMD) of the calcaneus. Serum fasting levels of gonadal hormones (prolactin, estradiol, testosterone, progesterone, follicle-stimulating hormone, luteinizing hormone) were determined. The relationship between osteoporosis and hormone levels was statistically analyzed by binary logistic regression analysis. Results Our results showed that patients with schizophrenia had a markedly higher rate of osteoporosis (24.4% vs. 10.1%) than healthy controls (P < 0.001). Patients with osteoporosis were older, had a longer disease course, and had a lower body mass index (BMI) than patients without osteoporosis (all P < 0.05). Regarding gonadal hormones, we found significantly higher prolactin, but lower estradiol, levels in patients with osteoporosis than in those without osteoporosis (both P < 0.05). The regression analysis revealed that PRL (OR = 1.1, 95% CI [1.08–1.15], P < 0.001) and E2 level (OR = 0.9, 95%CI [0.96–0.99], P = 0.011) were significantly associated with osteoporosis in patients with schizophrenia. Conclusion Our results indicate that patients with schizophrenia who are being treated with risperidone have a high rate of osteoporosis. Increased prolactin and reduced estradiol levels are significantly associated with osteoporosis.

The neglected association between schizophrenia and bone fragility: a systematic review and meta-analyses

“…Study characteristics: There were 17 studies published between 1997 and 2021 that examined associations between schizophrenia and BMD [49,50,[60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. The sample sizes ranged between 14 [70] to 229 [67] adults with schizophrenia.…”

“…Only one study was conducted within a population-based setting (Manitoba Bone Density Program database) [61], with all other studies conducted within clinical settings. Among these studies, 15 [49,50,60,[62][63][64][65][66][67][68][70][71][72][73][74] compared BMD between people with schizophrenia and a control group, one study [69] used reference data for age-and race-matched healthy males, while another study [61] compared the percentage of schizophrenia among people with low BMD and normal BMD. Seven studies [60,61,64,69,71,73] used an age-and sex-matched control group and other studies used only an age-matched [72] or sex-matched [49,65] control group.…”

“…Seven studies [60,61,64,69,71,73] used an age-and sex-matched control group and other studies used only an age-matched [72] or sex-matched [49,65] control group. The remaining studies used an aged-and sex-similar [70,74] or unmatched control group [50,62,63,66,67]. Two prospective studies [72,73] measured BMD before and after treatment with antipsychotic medication, of which we only included the baseline data (pre-treatment).…”

“…Most of the included studies that examined BMD used DXA as the ascertainment method; two studies used QUS [63,74] and another QCT [65]. Two studies [63,74] reported that QUS values were transformed to ascertain BMD, according to a previously published method (see Colling et al [75]). BMD sites varied across [61,71] and distal radius (n = 1) [69].…”

“…BMD sites varied across [61,71] and distal radius (n = 1) [69]. Two studies used QUS and subsequently reported bone density of the right heel [63,74]. The highest number of sites assessed was reported by Liang et al [71], measuring multiple sites, including lumbar spine: L1, L2, L3, L4, and L1-4, hip: femoral neck, trochanter, Ward's triangle, total hip, and radius: one-third distal, ultra-distal, middle distal, and total radius ulna [71].…”