Decreased Bone Mineral Density in Medicated Psychiatric Patients

Abstract

Osteoporosis is a common problem in postmenopausal women. It has been linked to estrogen deficiency, other neuroendocrine processes such as hypercortisolemia and male hypogonadism, nutritional deficiencies, and other mechanisms. Some of these changes have been also reported in male and female patients with mental disorders, especially those receiving psychotropic medications. Therefore, bone mineral density was measured by dual-photon absorptiometry in the lumbar spine and in the femoral neck of 33 female and 35 male consenting psychiatric inpatients admitted consecutively. Patients were diagnosed as having major depressive disorder (N = 21), schizophrenia (N = 33), schizoaffective disorder (N = 7), mania (N = 2), and adjustment disorder (N = 5). Plasma levels of prolactin, estrogen, cortisol, and testosterone were also measured in a subgroup of these patients. It is reported that female patients, but especially male patients, had a highly significant decrease in bone mineral density when compared with age- and sex-matched normal data. It is suggested that psychiatric patients treated with antidepressants or neuroleptics might have decreased bone mineral density than is normal for their age and sex, and may be at an increased risk for fractures. These results may be related to low levels of gonadal hormones, especially in male subjects. Data should be confirmed with a larger number of patients with and without medications to distinguish between diagnosis-related and treatment-related effects.

Depression and osteoporosis: epidemiology and potential mediating pathways

“…They found that the depressed group had BMD values, on average, 15% lower than the control group, after adjusting for age [6]. The majority of analyses have replicated the original 1994 finding of Schweiger et al lower BMD among persons with depression or depressive symptoms relative to comparison groups [7][8][9][10][11][12][13][14][15][16][17][18]. However, seven studies have not found a statistically significant association between depression or depressive symptoms and lower BMD [19][20][21][22][23][24][25].…”

“…However, Kavuncu et al (2002) did find evidence of increased bone turnover, indicated by an elevated urinary deoxypyridinolie-to-creatine ratio, among the depressed group compared to controls [21]. The remaining seven case-control studies reported statistically significant inverse associations between depression and bone mineral density [6,8,10,11,14,16,17]. For example, Michelson et al (1996) found that BMD as measured by DEXA was 13.6% lower at the femoral neck in women with a history of MDD compared to controls [11].…”

“…Both studies that used statistical modeling methods found that the association between depression and low BMD persisted after adjusting for antidepressant use [11,15]. Three studies only included cases that had a history of antidepressant use [8,11,12], and all found that depression was associated with decreased BMD. Two studies only included cases that had never used antidepressant medications [7,16], and both found that depression was associated with risk of osteoporosis.…”

Depression induces bone loss through stimulation of the sympathetic nervous system

“…Several studies, comparing altogether Ͼ200 patients with major depression and 240 controls, demonstrate a 6-15% lower BMD in the depressed patients. This decrease, which is indicative of osteoporosis, was found in both depressed women and men (1)(2)(3)(4). In most studies, the association between depression and low BMD was reported in patients older than 35-40 years (4-6), an age group targeted by osteoporosis and the associated increase in fracture incidence (7).…”

The effect of antipsychotics on bone mineral density in bipolar disorder: a case-controlled pilot study

“…In this regard, our findings are notable based on the indication that development of marked osteoporosis is also likely with use of atypical antipsychotics. While hyperprolactinemia developing secondary to drug therapy has been accused for the decrease in BMD in general, some authors indicate that the disease itself may have a direct role in the development of osteoporosis (10,22). Occurrence of low BMD in depression has been linked to increase in cortisol and decrease in estrogen levels (23).…”