Is antipsychotic treatment linked to low bone mineral density and osteoporosis? A review of the evidence and the clinical implications

Abstract

Objective-Osteoporosis is increasingly common worldwide and there is growing concern that the long-term use of antipsychotic medications increases the risk of this disorder. In this review we consider whether antipsychotics may contribute to the development of osteoporosis through reductions in bone mineral density (BMD), discuss the possible mechanisms involved and consider the clinical implications of such a relationship. Methods-We searched the literature for studies in this area published between 1966 and 2010 using the Medline and PubMed databases and the following search terms: (schizophrenia OR antipsychotic OR neuroleptic) AND (osteoporosis OR hyperprolactinaemia OR bone mineral density).Results-The available data indicates that statistically significant reductions in bone mineral density are frequently seen in patients prescribed antipsychotic medications and suggests that there is a higher incidence of clinically significant reductions compared with the normal population.Conclusions-Clinicians should be aware for the potential negative effects of antipsychotic medications on bone mineral density, particularly in patients with additional risk factors for osteoporosis. Recommendations regarding routine monitoring of bone mineral density for patients prescribed antipsychotic medications cannot be made on the basis of existing evidence and more research is required. Is antipsychotic treatment linked to low bone mineral density and osteoporosis? A review of the evidence and the clinical implications

Evaluation of Serum Prolactin Levels in Intellectually Disabled Patients Using Antipsychotic Medications

“…A suspected relationship seen with hyperprolactinemia secondary to AP use is osteoporosis leading to fractures (10). This relationship is supported by a recent review of studies (11). A positive correlation between elevated PRL levels and decreased bone mineral density has been found for both men and women (12, 13).…”

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

“…The principal drugs with well-known negative effects on BMD in bipolar disorder are lithium, valproate and haloperidol (9). Our findings are important to show that atypical antipsychotic have negative effects on BMD in patients with bipolar disorder.…”

“…used in the treatment of these diseases. Being more commonly encountered among young female and males, the incidence of secondary osteoporosis may reach up to 64% particularly in males (4 (9). Antipsychotic medications have been proposed to lead a reduction in BMD via decreasing gonadal hormone levels and increasing prolactin levels (9,10).…”

“…Antipsychotic medications are commonly used in treatment of bipolar disorder, while it is not so simple to decide whether osteoporosis is secondary to underlying disease or due to side effect of the drugs. Data available in literature on the effect of antipsychotic medications on BMD in patients with bipolar disorder are based on limited number of small-scale studies (9)(10)(11).…”

Hyperprolactinaemia in first episode psychosis - A longitudinal assessment

“…These effects are particularly marked on bone integrity, increasing the risk for low bone mineral density (Crews and Howes, 2012), osteoporosis (O'Keane, 2008), and osteoporotic fractures .These effects could be additive to those of low vitamin D, commonly seen in psychosis (Crews et al, 2013;Lally et al, 2016). Our findings of high rates of HPL in this young population of antipsychotic treated patients, is important given the putative detrimental effect on bone mineral density (Crews and Howes, 2012), and the fact that exposure to antipsychotic medication and hyperprolactinaemia is likely to be present over a prolonged period of time. However, given the multifactorial aetiology for many of these adverse effects, uncertainty relating to the specific physical effects of hyperprolactinaemia persists, and probably contributes to the low level of monitoring which occurs in clinical practice.…”