Osteoporosis, Schizophrenia and Antipsychotics: the Need for a Comprehensive Multifactorial Evaluation

Overview

Journal CNS Drugs

Specialties Neurology
Pharmacology

Date 2007 Jul 17

PMID 17630817

Citations 16

Authors

Uriel Halbreich

Affiliations

Soon will be listed here.

Abstract

Osteoporosis is recognised as a major public health issue leading to bone fractures, pain and disability. Awareness of an elevated risk of osteoporosis in individuals with schizophrenia is increasing. An accelerated decrease in bone mineral density (BMD) in patients with schizophrenia may be disease related or drug induced. A drug-induced decrease in BMD has been attributed mostly to hyperprolactinaemia and its consequences. However, as demonstrated in this review, decreased BMD and osteoporosis are multifactorial processes, and abnormal bone structure and functions are not limited to BMD. Multiple dynamic processes may lead to impairment of bone homeostasis and eventually to bone abnormalities. Many of these processes may be abnormal in treated as well as untreated patients with schizophrenia. Despite many publications, the epidemiology of abnormal bone structure, mineralisation and dynamics in patients with schizophrenia is still not fully determined. Comprehensive studies of bone dynamics in individuals with first-episode schizophrenia, as well as in patients treated with various current medications, are needed in order to characterise the problem(s) and then to develop relevant treatment and prevention strategies.

Citing Articles

Association of schizophrenia with fracture-related femoral neck displacement: A cross-sectional retrospective study.

Inoue Y, Tokushige A, Kinjyo T, Ueda S PCN Rep. 2024; 3(2):e195.

PMID: 38868087 PMC: 11114322. DOI: 10.1002/pcn5.195.

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

Azimi Manavi B, Corney K, Mohebbi M, Quirk S, Stuart A, Pasco J Transl Psychiatry. 2024; 14(1):225.

PMID: 38816361 PMC: 11139985. DOI: 10.1038/s41398-024-02884-1.

A trans-ethnic two-stage polygenetic scoring analysis detects genetic correlation between osteoporosis and schizophrenia.

Liu L, Wen Y, Ning Y, Li P, Cheng B, Cheng S Clin Transl Med. 2020; 9(1):21.

PMID: 32107650 PMC: 7046891. DOI: 10.1186/s40169-020-00272-y.

Long-term Use of Clozapine is Protective for Bone Density in Patients with Schizophrenia.

Lin C, Lin C, Wang H, Lane H Sci Rep. 2019; 9(1):3895.

PMID: 30846868 PMC: 6405997. DOI: 10.1038/s41598-019-40691-7.

A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice.

Motyl K, Beauchemin M, Barlow D, Le P, Nagano K, Treyball A Bone. 2017; 103:168-176.

PMID: 28689816 PMC: 5573184. DOI: 10.1016/j.bone.2017.07.008.

References

Crawford A, Beasley Jr C, Tollefson G . The acute and long-term effect of olanzapine compared with placebo and haloperidol on serum prolactin concentrations. Schizophr Res. 1997; 26(1):41-54. DOI: 10.1016/S0920-9964(97)00036-4. View

Liu-Seifert H, Kinon B, Ahl J, Lamberson S . Osteopenia associated with increased prolactin and aging in psychiatric patients treated with prolactin-elevating antipsychotics. Ann N Y Acad Sci. 2005; 1032:297-8. DOI: 10.1196/annals.1314.044. View

Abraham G, Paing W, Kaminski J, Joseph A, Kohegyi E, Josiassen R . Effects of elevated serum prolactin on bone mineral density and bone metabolism in female patients with schizophrenia: a prospective study. Am J Psychiatry. 2003; 160(9):1618-20. DOI: 10.1176/appi.ajp.160.9.1618. View

Garnero P, Borel O, Sornay-Rendu E, Delmas P . Vitamin D receptor gene polymorphisms do not predict bone turnover and bone mass in healthy premenopausal women. J Bone Miner Res. 1995; 10(9):1283-8. DOI: 10.1002/jbmr.5650100902. View

Willing M, Sowers M, Aron D, Clark M, Burns T, Bunten C . Bone mineral density and its change in white women: estrogen and vitamin D receptor genotypes and their interaction. J Bone Miner Res. 1998; 13(4):695-705. DOI: 10.1359/jbmr.1998.13.4.695. View

Howes O, Wheeler M, Meaney A, OKeane V, Fogelman I, Blake G . Bone mineral density and its relationship to prolactin levels in patients taking antipsychotic treatment. J Clin Psychopharmacol. 2005; 25(3):259-61. PMC: 3666284. DOI: 10.1097/01.jcp.0000162798.87249.4d. View

Vignery A, Niven-Fairchild T, Shepard M . Recombinant murine interferon-gamma inhibits the fusion of mouse alveolar macrophages in vitro but stimulates the formation of osteoclastlike cells on implanted syngeneic bone particles in mice in vivo. J Bone Miner Res. 1990; 5(6):637-44. DOI: 10.1002/jbmr.5650050613. View

Schlechte J, Sherman B, Martin R . Bone density in amenorrheic women with and without hyperprolactinemia. J Clin Endocrinol Metab. 1983; 56(6):1120-3. DOI: 10.1210/jcem-56-6-1120. View

Lean M, de Smedt G . Schizophrenia and osteoporosis. Int Clin Psychopharmacol. 2004; 19(1):31-5. DOI: 10.1097/00004850-200401000-00006. View

10.

Takacs I, Koller D, Peacock M, CHRISTIAN J, Hui S, Conneally P . Sibling pair linkage and association studies between bone mineral density and the insulin-like growth factor I gene locus. J Clin Endocrinol Metab. 1999; 84(12):4467-71. DOI: 10.1210/jcem.84.12.6179. View

11.

Wallace B, Cumming R . Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcif Tissue Int. 2000; 67(1):10-8. DOI: 10.1007/s00223001089. View

12.

Francis R, Peacock M, Aaron J, Selby P, Taylor G, Thompson J . Osteoporosis in hypogonadal men: role of decreased plasma 1,25-dihydroxyvitamin D, calcium malabsorption, and low bone formation. Bone. 1986; 7(4):261-8. DOI: 10.1016/8756-3282(86)90205-x. View

13.

Foresta C, Scanelli G, Zanatta G, Busnardo B, Scandellari C . Reduced calcitonin reserve in young hypogonadic osteoporotic men. Horm Metab Res. 1987; 19(6):275-7. DOI: 10.1055/s-2007-1011797. View

14.

Lofman O, Larsson L, Toss G . Bone mineral density in diagnosis of osteoporosis: reference population, definition of peak bone mass, and measured site determine prevalence. J Clin Densitom. 2000; 3(2):177-86. DOI: 10.1385/jcd:3:2:177. View

15.

Casey D . Side effect profiles of new antipsychotic agents. J Clin Psychiatry. 1996; 57 Suppl 11:40-5; discussion 46-52. View

16.

Hummer M, Malik P, Gasser R, Hofer A, Kemmler G, Moncayo Naveda R . Osteoporosis in patients with schizophrenia. Am J Psychiatry. 2004; 162(1):162-7. DOI: 10.1176/appi.ajp.162.1.162. View

17.

OKeane V, Meaney A . Antipsychotic drugs: a new risk factor for osteoporosis in young women with schizophrenia?. J Clin Psychopharmacol. 2005; 25(1):26-31. DOI: 10.1097/01.jcp.0000150223.31007.e0. View

18.

Soyka L, Fairfield W, Klibanski A . Clinical review 117: Hormonal determinants and disorders of peak bone mass in children. J Clin Endocrinol Metab. 2000; 85(11):3951-63. DOI: 10.1210/jcem.85.11.6994. View

19.

David S, TAYLOR C, Kinon B, Breier A . The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. Clin Ther. 2000; 22(9):1085-96. DOI: 10.1016/S0149-2918(00)80086-7. View

20.

Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper J . Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl. 1992; 20:1-97. DOI: 10.1017/s0264180100000904. View