Effects of antipsychotics on bone mineral density and prolactin levels in patients with schizophrenia: a 12-month prospective study

Abstract

Objective Effects of conventional and atypical antipsychotics on bone mineral density (BMD) and serum prolactin levels (PRL) were examined in patients with schizophrenia. Methods One hundred and sixty-three first-episode inpatients with schizophrenia were recruited, to whom one of three conventional antipsychotics (perphenazine, sulpiride, and chlorpromazine) or one of three atypical antipsychotics (clozapine, quetiapine, and aripiprazole) was prescribed for 12 months as appropriate. BMD and PRL were tested before and after treatment. Same measures were conducted in 90 matched healthy controls. Results Baseline BMD of postero-anterior L1-L4 range from 1.04 ± 0.17 to 1.42 ± 1.23, and there was no significant difference between the patients group and healthy control group. However, post-treatment BMD values in patients (ranging from 1.02 ± 0.15 to 1.23 ± 0.10) were significantly lower than that in healthy controls (ranging from 1.15 ± 0.12 to 1.42 ± 1.36). The BMD values after conventional antipsychotics were significantly lower than that after atypical antipsychotics. The PRL level after conventional antipsychotics (53.05 ± 30.25 ng/ml) was significantly higher than that after atypical antipsychotics (32.81 ± 17.42 ng/ml). Conditioned relevance analysis revealed significant negative correlations between the PRL level and the BMD values after conventional antipsychotics. Conclusion The increase of PRL might be an important risk factor leading to a high prevalence of osteoporosis in patients with schizophrenia on long-term conventional antipsychotic medication.

Lower Bone Mineral Density at the Hip and Lumbar Spine in People with Psychosis Versus Controls: a Comprehensive Review and Skeletal Site-Specific Meta-analysis

“…After removal of any duplicate articles, 3447 titles and abstracts were screened, of which 76 were assessed at full-text level for suitability for inclusion. Of these, ten met the necessary criteria for inclusion in the meta-analysis [21–23, 35–41]. Two studies did not provide the full details of BMD measurements [42, 43].…”

“…The mean age of the control group was 34.7 years (SD = 9.1 years) and 58.7 % were female. Seven studies were conducted in Europe [21–23, 36, 37, 40, 41], and three in Asia [35, 38, 39]. Sample sizes ranged from 14 [37] to 229 [38].…”

Elucidating the Mechanism(s) Underlying Antipsychotic- and Antidepressant-Mediated Fractures

“…It is not clear, however, if the drug-associated increase in falls is the sole cause of increased fractures, or if other mechanisms are also at play. Specifically, a number of recent cross-sectional and longitudinal clinical studies have found that AA use is associated with reduced BMD and increased fracture risk in both men and women [15][16][17][18] . Serum concentrations of a bone turnover marker, β-CrossLaps, were higher in patients treated with AA (n=31 drug-naïve first episode patients and n=85 AA monotherapy for 6 months) vs. drug-naive first-episode patients and normal subjects 19 .…”

“…Serum concentrations of a bone turnover marker, β-CrossLaps, were higher in patients treated with AA (n=31 drug-naïve first episode patients and n=85 AA monotherapy for 6 months) vs. drug-naive first-episode patients and normal subjects 19 . A prospective study found that BMD in 120 firstepisode inpatients with schizophrenia prescribed either clozapine, quetiapine or aripiprazole was significantly lower than in matched healthy controls (n=90), 12-months after drug initiation 17 . In pediatric patients, AA-associated fractures were increased 2-3 fold with an associated reduction in bone mass [20][21] .…”

Do Antipsychotics Cause Hip Fractures? Promise and Pitfalls of Big Data

“…3 Mechanisms that could help explain the relationship between hip fractures and antipsychotic use include prolactin elevation, extrapyramidal symptoms, sedative effects, and postural hypotension. Long-term exposure to prolactinelevating antipsychotics leads to reduced bone mineral density (BMD), 6,7 and markers of bone reabsorption correlate with prolactin elevation, while discontinuation of antipsychotics can cause improvement in markers of bone resorption. 8 Hip fractures are more common with antipsychotics that elevate prolactin than prolactin-sparing antipsychotics.…”