Antipsychotic Medication in Schizophrenic Patients is Associated with Higher Risks of Developing Bone Fractures and Refractures

Kuo, Ching Min; Liao, Wei Jen; Huang, Chun Che; Lan, Tsuo Hung; Lin, Ching Heng; Wang, Shun Ping; Lee, Cheng Hung; Lui, Ping-Wing

doi:10.9758/cpn.2020.18.4.562

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…Schizophrenia is a severe, complex and neuropsychiatric disorder with marked functional impairment posing a considerable societal burden [ 1 , 2 ], affecting about 1% of the world’s population. Compared with the general population, patients with schizophrenia experience poor general health outcomes, including increased risks of osteoporosis which is characterized by abnormally low bone mineral density (BMD), and fracture, especially hip fracture [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

The causal effect of schizophrenia on fractures and bone mineral density: a comprehensive two-sample Mendelian randomization study of European ancestry

Jia,

Dong,

et al. 2023

BMC Psychiatry

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Background Schizophrenia was clinically documented to co-occur with fractures and aberrant bone mineral density (BMD), but the potential causal relationship remained unclear. This study aimed to test the causal effects between schizophrenia and fractures as well as aberrant BMD by conducting Mendelian randomization (MR) analyses. Methods Two-sample MR was utilized, based on instrumental variables from large genome-wide association studies (GWAS) of schizophrenia as exposure, to identify the causal association of schizophrenia with mixed fractures, fractures at different body sites (including skull and facial bones, shoulder and upper arm, wrist and hand, and femur) and BMDs of forearm (FA), femoral neck (FN), lumbar spine (LS) and estimated BMD (eBMD). Multivariable Mendelian randomization (MVMR) analysis was performed to minimize the confounding effect of body mass index (BMI). Results Result from inverse variance weighting (IVW) method provided evidence schizophrenia increased the risk of fractures of skull and facial bones [odds ratio (OR) = 1.0006, 95% confidence interval (CI): 1.0003 to 1.0010] and femur [OR =1.0007, 95% CI: 1.0003 to 1.0011], whereas, decreased the level of eBMD [β (95%CI): -0.013 (-0.021, -0.004)]. These causal effects still existed after adjusting for BMI. Sensitivity analyses showed similar results. However, no causal effect of schizophrenia on fracture or BMD in other parts was detected. Conclusion The current finding confirmed that schizophrenia was causally associated with the fractures of skull, face and femur as well as eBMD, which might remind psychiatrists to pay close attention to the fracture risk in schizophrenic patients when formulating their treatment strategies.

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Section: Introductionmentioning

confidence: 99%

The causal effect of schizophrenia on fractures and bone mineral density: a comprehensive two-sample Mendelian randomization study of European ancestry

Jia,

Dong,

et al. 2023

BMC Psychiatry

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Comparative analysis of psychiatric medications and their association with falls and fractures: A systematic review and network meta-analysis

Guo,

Tao,

Xiong

et al. 2024

Psychiatry Research

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Antipsychotic-induced bone loss: the role of dopamine, serotonin and adrenergic receptor signalling

Weerasinghe

Hodge

Pasco

et al. 2023

Front. Cell Dev. Biol.

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Antipsychotics are commonly used in treating psychiatric disorders. These medications primarily target dopamine the serotonin receptors, they have some affinity to adrenergic, histamine, glutamate and muscarinic receptors. There is clinical evidence that antipsychotic use decreases BMD and increases fracture risk, with dopamine, serotonin and adrenergic receptor-signalling becoming an increasing area of focus where the presence of these receptors in osteoclasts and osteoblasts have been demonstrated. Osteoclasts and osteoblasts are the most important cells in the bone remodelling and the bone regeneration process where the activity of these cells determine the bone resorption and formation process in order to maintain healthy bone. However, an imbalance in osteoclast and osteoblast activity can lead to decreased BMD and increased fracture risk, which is also believed to be exacerbated by antipsychotics use. Therefore, the aim of this review is to provide an overview of the mechanisms of action of first, second and third generation antipsychotics and the expression profiles of dopamine, serotonin and adrenergic receptors during osteoclastogenesis and osteoblastogenesis.

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Antipsychotic Medication in Schizophrenic Patients is Associated with Higher Risks of Developing Bone Fractures and Refractures

Cited by 3 publications

References 18 publications

The causal effect of schizophrenia on fractures and bone mineral density: a comprehensive two-sample Mendelian randomization study of European ancestry

The causal effect of schizophrenia on fractures and bone mineral density: a comprehensive two-sample Mendelian randomization study of European ancestry

Comparative analysis of psychiatric medications and their association with falls and fractures: A systematic review and network meta-analysis

Antipsychotic-induced bone loss: the role of dopamine, serotonin and adrenergic receptor signalling

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