Long Term Use of Antipsychotics and Adverse Effects on Bone Density

Rady, Ahmed; Elsheshai, Adel; Elkholy, Osama; Abouelwafa, Heba; Eltawil, Mohamed A.

doi:10.4172/neuropsychiatry.1000491

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…This collection of articles encourages the greater use of lithium despite as a fundamental treatment for bipolar disease. To our knowledge, other commonly used medications for bipolar disease such as anti-depressants, anti-convulsants, and neuroleptics are associated with low BMD (Crews and Howes, 2012;Rady et al, 2018;Zhou et al, 2018). Lithium may be a better treatment option for bipolar disease patients with low BMD taking into consideration the side effects of lithium.…”

Section: Research Gap and Future Perspectivesmentioning

confidence: 99%

The Skeletal-Protecting Action and Mechanisms of Action for Mood-Stabilizing Drug Lithium Chloride: Current Evidence and Future Potential Research Areas

Wong

Chin

2020

Front. Pharmacol.

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Lithium, the lightest natural-occurring alkali metal with an atomic number of three, stabilizes the mood to prevent episodes of acute manic and depression. Multiple lines of evidence point to lithium as an anti-suicidal, anti-viral, anti-cancer, immunomodulatory, neuroprotective and osteoprotective agent. This review article provides a comprehensive review of studies investigating the bone-enhancing effects of lithium and its possible underlying molecular mechanisms. Most of the animal experimental studies reported the beneficial effects of lithium in defective bones but not in healthy bones. In humans, the effects of lithium on bones remain heterogeneous. Mechanistically, lithium promotes osteoblastic activities by activating canonical Wingless (Wnt)/beta (b)-catenin, phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) and bone morphogenetic protein-2 (BMP-2) transduction pathways but suppresses osteoclastic activities by inhibiting the receptor activator of nuclear factor-kappa B (RANK)/receptor activator of nuclear factor-kappa B ligand (RANKL)/osteoprotegerin (OPG) system, nuclear factorkappa B (NF-kB), mitogen-activated protein kinase (MAPK), and calcium signaling cascades. In conclusion, lithium confers protection to the skeleton but its clinical utility awaits further validation from human clinical trials.

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Section: Research Gap and Future Perspectivesmentioning

confidence: 99%

The Skeletal-Protecting Action and Mechanisms of Action for Mood-Stabilizing Drug Lithium Chloride: Current Evidence and Future Potential Research Areas

Wong

Chin

2020

Front. Pharmacol.

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“…Earlier studies have reported that patients receiving typical antipsychotics had greater risks of hip fractures [13]. Other studies also found higher risks of falls with atypical antipsychotics [15], as well as more nonvertebral osteoporotic and hip fractures [15,16]. It is likely that underlying cause of fractures is falls.…”

Section: Discussionmentioning

confidence: 98%

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

Kuo

Liao

Huang

et al. 2020

Clin Psychopharmacol Neurosci

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Objective The relationship of antipsychotics and the risk of refracture in treated patients is unclear. The aim of this study is to evaluate the association between prolonged antipsychotic and the incidences of bone fractures and refractures in schizophrenia. Methods This is a retrospective nested case-control study using Taiwan National Health Insurance Research Database recorded from 2000 to 2005, with cases followed up to end of 2011. Total of 7,842 schizophrenic patients, 3,955 had developed bone fractures were compared with 3,887 control subjects matched in age, sex, and index date. Antipsychotic drug exposure was classified based on the drug type and medication duration. Conditional logistic regression analyses were performed. Odds ratio (OR) and confidence interval (CI) were calculated. Results We found (after adjustments) higher risks of developing fractures under continued use of typical (OR = 1.70; 95% CI, 1.51−1.91) or atypical antipsychotics (OR = 1.43; 95% CI, 1.28−1.60) were found. Additionally, continued use typical (OR = 1.84; 95% CI, 1.35−2.50) or atypical antipsychotics (OR = 1.44; 95% CI, 1.06−1.95) was positively associated with refracture risks. Moreover, refractures were associated with continuous use of chlorpromazine (one typical antipsychotics, OR = 2.45; 95% CI, 1.14−5.25), and risperidone (OR = 1.48; 95% CI, 1.01−2.16) or zotepine (OR = 2.15; 95% CI, 1.06−4.36) (two atypical antipsychotics). Conclusion Higher risks of bone fracture and refracture were found in schizophrenia under prolonged medication with typical or atypical antipsychotics. We therefore recommend that clinicians should pay more attention on bone density monitoring for patients using long-term antipsychotics.

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“…The direct mechanism on bone is the presence of prolactin receptors on osteoblasts, which have been shown to reduce the number of osteoblasts, causing decreased bone proliferation and density [15]. The indirect mechanism through the hypothalamic-pituitary-gonadal axis using suppression of gonadal hormone levels causes abnormal bone metabolism and an increase in osteoclast activity, which is not compensated by an increase in osteoblast activity [15][16][17]. Mild hyperprolactinemia causes greater bone resorption than bone formation, and severe hyperprolactinemia stimulates bone resorption and inhibits bone formation, resulting in bone microdamage [18].…”

Section: Effects On Bonesmentioning

confidence: 99%

Hyperprolactinemia as a side effect of using antipsychotics In Schizophrenic Patients

Anwar,

Khairina

2023

JPS

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Introductions: Antipsychotics are still the mainstay of schizophrenia management. Antipsychotics are antagonistic to postsynaptic dopamine receptors in the brain. Blockade of dopamine receptors in the tuberoinfundibular pathway by antipsychotics will cause the side effect of hyperprolactinemia. Objectives: This review describes hyperprolactinemia induced by antipsychotic use and its clinical effects, monitoring, and management. Methods: reference search through Google Scholar with keywords schizophrenia, antipsychotics, prolactin, hyperprolactinemia, clinical effects of hyperprolactinemia, diagnosis of hyperprolactinemia, monitoring of hyperprolactinemia, management of hyperprolactinemia. Results: Clinicians need to take a diagnostic approach to identify the etiology of hyperprolactinemia, monitor the clinical symptoms of hyperprolactinemia during the administration of antipsychotics, and immediately carry out management according to existing strategies by considering some general principles and considerations. Conclusions: Schizophrenia is a severe mental disorder that lasts long, requiring long-term and continuous therapy. Administration of antipsychotics is still a mainstay in the management of schizophrenia. Antipsychotics are antagonists to postsynaptic dopamine receptors in the brain. The antipsychotic effect of blocking dopamine receptors not only improves the symptoms of schizophrenia but also causes side effects. The side effect when the tuberoinfundibular dopamine pathway is blocked is an increase in prolactin levels called hyperprolactinemia.

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Long Term Use of Antipsychotics and Adverse Effects on Bone Density

Cited by 4 publications

References 23 publications

The Skeletal-Protecting Action and Mechanisms of Action for Mood-Stabilizing Drug Lithium Chloride: Current Evidence and Future Potential Research Areas

The Skeletal-Protecting Action and Mechanisms of Action for Mood-Stabilizing Drug Lithium Chloride: Current Evidence and Future Potential Research Areas

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

Hyperprolactinemia as a side effect of using antipsychotics In Schizophrenic Patients

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