Parameters of Calcium Metabolism Fluctuated during Initiation or Changing of Antipsychotic Drugs

Abstract

ObjectiveSerum parameters of calcium homeostasis were measured based on previously published evidence linking osteoporotic fractures and/or bone/mineral loss with antipsychotics.MethodsProspective, four-week, time-series trial was conducted and study population consisted of patients of both genders, aged 35-85 years, admitted within the routine practice, with acute psychotic symptoms, to whom an antipsychotic drug was either introduced or substituted. Serial measurements of serum calcium, phosphorous, magnesium, 25(OH)D, parathyroid hormone, calcitonin, osteocalcin and C-telopeptide were made from patient venous blood samples.ResultsCalcium serum concentrations significantly decreased from baseline to the fourth week (2.42±0.12 vs. 2.33±0.16 mmol/L, p=0.022, n=25). The mean of all calcemia changes from the baseline was -2.6±5.7% (-24.1 to 7.7) with more decreases than increases (78 vs. 49, p=0.010) and more patents having negative sum of calcemia changes from baseline (n=28) than positive ones (n=10) (p=0.004). There were simultaneous falls of calcium and magnesium from baseline (63/15 vs. 23/26, p<0.001; OR=4.75, 95% CI 2.14-10.51), phosphorous (45/33 vs. 9/40, p<0.001; 6.06, 2.59-14.20) and 25(OH)D concentrations (57/21 vs. 13/35, p<0.001; 7.31, 3.25-16.42), respectively. Calcemia positively correlated with magnesemia, phosphatemia and 25(OH)D values. Parathyroid hormone and C-telopeptide showed only subtle oscillations of their absolute concentrations or changes from baseline; calcitonin and osteocalcin did not change. Adjustment of final calcemia trend (depletion/accumulation) for relevant risk factors, generally, did not change the results.ConclusionIn patients with psychotic disorders and several risks for bone metabolism disturbances antipsychotic treatment was associated with the decrease of calcemia and changes in levels of the associated ions.

Vitamin D in patients with intellectual and developmental disability in secure in-patient services in the North of England, UK

“…Although no significant differences were found between patients taking psychotropic medication and those who were not, these factors remain of clinical concern with respect to bone health. A recent small-scale prospective study found that antipsychotics may inhibit vitamin D-metabolising enzymes, thereby causing a reduction in both calcium and 25OHD levels 10 . This association is of particular concern given the known link between antipsychotics and osteoporosis risk via raised prolactin levels 11 …”

Calcium Levels Differences in Men with Schizophrenia Treated with Olanzapine and Risperidone in Prof. Dr. M Ildrem Psychiatric Hospital Medan

“…This result is in line with another study conducted by Lee et al in 2010 in South Korea, which also investigated factors related to bone metabolism, including plasma calcium level between those receiving 1 mg risperidone and 2.5 mg of olanzapine. They found a significant decrease of bone density in schizophrenic patients prescribed with risperidone and olanzapine (p < 0.05), which is correlated to baseline calcium level [8].…”

“…In addition to the osteoporosis process, the increased risk of fracture is well documented in treated patients with severe mental disorders. The decrease in calcium levels with antipsychotic therapy may be caused by several mechanisms, including the excretion mechanism in the kidneys, a condition where there is an increase in the excretion of calcium in the urine, and vice versa when there is low absorption of calcium [8].…”

Effects of antidepressants on serum concentrations of bone metabolism markers and major electrolytes in patients from routine psychiatric practice

“…Sample size calculation was powered with  and  error 0.05 and 0.2, respectively, considering the decrease of 5% of serum calcemia (primary outcome variable) in final blood sample from baseline calcemia of 2.40 mmol/L (standard deviation 0.16 mmol/L) as statistically significant, for paired, two-tailed, one-sample analysis. We based calculation on previous research in the topic but concerning antipsychotic treatment as we consider available data of primary endpoint from studies, which investigated antidepressants in the similar setting to be scarce and unreliable 17 . The initial computed sample size was increased for a half, in order to counteract possible non-parametric distribution and missing data, giving the study group of at least 25 subjects.…”

“…Instead, sedatives increase fracture risk mainly due to gait disturbances and antipsychotics induce hyperprolactinemia and hypogonadism predisposing patients to osteoporosis. In fact, the fracture risk in people taking antipsychotic drugs had much more magnitude than in patients taking antidepressants [34][35][36] ; moreover, they could significantly disturb calcemia in the notable number of patients, manly toward low levels 17 . Therefore, if anxiolytics and antipsychotics used by patients in our study did influence bone mineral homeostasis and their serum levels, the aggregate resultant would either facilitate or counteract presumed action of antidepressants.…”