Osteoporosis in Patients With Schizophrenia

Hummer, Martina; Malík, Peter; Gasser, R.; Hofer, Alex; Kemmler, Georg; Naveda, Roy Cesar Moncayo; Rettenbacher, Maria A.; Fleischhacker, W. Wolfgang

doi:10.1176/appi.ajp.162.1.162

Cited by 107 publications

(82 citation statements)

References 31 publications

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“…Male patients with schizophrenia treated for at least 1 year with oral risperidone had normal markers of bone remodeling in more than 60% of patients, while BMD at the lumbar region was lower than in healthy subjects [41]. This is in contrast with Bergeman et al [42] who reported high bone turnover but normal BMD in young women with schizophrenia.…”

Section: Discussionmentioning

confidence: 99%

Bone Remodeling, Bone Mass and Weight Gain in Patients with Stabilized Schizophrenia in Real-Life Conditions Treated with Long-Acting Injectable Risperidone

Doknic¹,

Maric²,

Britvić³

et al. 2011

Neuroendocrinology

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Background: Prolactin-raising antipsychotics, risperidone (antidopaminergic activity), may be associated with low bone mass. On the other hand, risperidone may cause an increase in body weight thought to be favorable for bone. Objectives: (1) To determine bone remodeling parameters and bone mass in patients with schizophrenia on long-term treatment with long-acting injectable risperidone (LAIR) in naturalistic settings, and (2) to evaluate the change in body weight, metabolic profile and neuroendocrine status in these patients. Design: This was a prospective, cross-sectional study. Patients: Patients included 26 outpatients with controlled schizophrenia in real-life conditions (age 31.3 ± 1.3 years, BMI 28.1 ± 1.0) on long-term maintenance therapy with LAIR for a mean of 18.0 ± 1.6 months (range 6–36) with a mean dose of 38 ± 2 mg. 35 subjects matched for sex, age, BMI and education served as healthy controls. Methods: Serum osteocalcin, C-terminal telopeptide of type I collagen (CTx), vitamin D, leptin, prolactin, sex steroids, and parathyroid hormone were assessed. Indices of insulin sensitivity and resistance were determined following an oral glucose tolerance test (OGTT). Bone mineral density (BMD) was measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN). Results: Mild to moderate hyperprolactinemia (1,000–2,000 mU/l) was associated with asymptomatic hypogonadism. Prolactin values >2,000 mU/l occurred in a few female patients. Hypogonadism leads to a slight increase (upper limit of normal) in bone resorption marker (CTx) in patients with schizophrenia (p = 0.023). As for bone mass, although lower at the spine than in healthy subjects, it did not reach statistical significance (p = 0.094), while at the FN, BMD was not different from healthy subjects. Body weight increased on average 8.7 ± 1.6 kg in more than 50% of patients. Leptin levels adjusted for BMI in females were significantly higher in patients than in healthy female subjects (p = 0.018), while in males there was no difference between the groups (p = 0.833). A high prevalence of low vitamin D levels and more current smokers were found in patients with schizophrenia. As for the metabolic profile during treatment with risperidone, the low Matsuda index of insulin sensitivity (p = 0.039) confirmed insulin resistance in these patients. Conclusion: A potential long-term consequence of asymptomatic hypogonadism due to risperidone-induced hyperprolactinemia might cause a slight rise in bone resorption marker (CTx). On the other hand, by increasing body weight, risperidone could have a protective effect on the bone and thus no change in bone mass was recorded when compared with healthy controls.

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Section: Discussionmentioning

confidence: 99%

Bone Remodeling, Bone Mass and Weight Gain in Patients with Stabilized Schizophrenia in Real-Life Conditions Treated with Long-Acting Injectable Risperidone

Doknic¹,

Maric²,

Britvić³

et al. 2011

Neuroendocrinology

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“…Although some studies examined only small samples (range 10-402 patients), thirteen studies published between 1980 and 2005 consistently found decreased bone mineral density (osteoporosis) of people with schizophrenia compared to normal controls (69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). One reason for this finding is that many antipsychotic drugs increase prolactin levels.…”

Section: Musculoskeletal Diseases (316 Medline Hits)mentioning

confidence: 99%

Physical illness and schizophrenia: a review of the literature

Leucht

Burkard

Henderson³

et al. 2007

Acta Psychiatr Scand

563

358

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Sartorius N. Physical illness and schizophrenia: a review of the literature.Objective: The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. Method: We searched MEDLINE (1966( -May 2006 combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. Results: A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. Conclusion: The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients. Summations• According to this review it has been known for decades that incidences physical diseases are frequent in schizophrenia. Nevertheless, some areas such as infectious diseases have not been sufficiently studied.• Psychiatrists are often not trained well enough in the detection and treatment of physical diseases.They must be aware of the frequent medical comorbidities and should play a more active role in their diagnosis, prevention, and treatment.• Other necessary strategies include the education of patients, general practitioners and of doctors working in other medical specialities. The access to medical care of the mentally ill also needs to be improved, among others, by reducing the stigma associated with mental disorders. Considerations• The review covered a broad area of research accordingly, focusing attention to details has not been possible.• Despite the broad search strategy, studies not covered by MEDLINE or not indexed by the MeSH term of schizophrenia could have been missed. • Due to considerable differences in the design and quality of the studies in assorted and diverse areas, quantitative approaches using meta-analysis were not possible, but should be the target of future reviews focusing.

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“…It is thought that time of onset of schizophrenia can be 5 years earlier in men than women (32). For this reason, exposure to factors related with schizophrenia and which may affect bone mineral density is longer for male patients (16). In our study, although it was found that gender has no effect on bone mineral density, low number of patients and not exactly knowing ages of disease onset in our patient group can be interpreted as limitations of our study.…”

Section: Discussionmentioning

confidence: 54%

“…There are several studies showing low bone mineral density in chronic schizophrenia patients (14,16,22). Polydypsia (23), neuroleptic use and related hyperprolactinemia (8,(24)(25)(26)(27)(28)(29), excessive smoking (11), substance and alcohol dependence (6) and lack of mobility (30) are among risk factors of higher osteoporosis prevalence among psychiatric patients.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of bone mineral density levels in young-adult patients with schizophrenia and healthy controls / Genç-erişkin şizofreni hastalarında kemik mineral yoğunluğu düzeyinin sağlıklı kontrollerle karşılaştırılması

Koçer¹,

Yazıcı²,

Canan³

2011

Dusunen Adam

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Objective: The aim of this study was to assess bone mineral density levels of patients with schizophrenia and to compare the results with healthy controls. Methods: Fourteen patients with schizophrenia and 31 healthy controls, between 22 and 44 years of age, were enrolled in this cross-sectional study. Bone mineral density (BMD) levels of each group were measured by Dual Energy X-ray Absorbiometry (DEXA). The patients were assessed using the Positive and Negative Symptom Scale (PANSS). All patients had been receiving antipsychotic treatment for at least 2 years. Patients' sociodemographic caharacteristics and risk factors for osteoporosis (antipsychotic use, sunlight exposure, physical activity, etc.) were documented. Results: As compared with the healthy controls, the patients with schizophrenia had significantly lower BMD at the lumbar spine and at all sites of the proximal femur. Correlation analysis showed that the only factor related with the femoral BMD only in patients with schizophrenia was the age. No association between BMD and gender, PANSS score, type of antipsychotic medications, and other risk factors for osteoporosis were observed. Conclusions: In this study, we found that BMD in schizophrenia patients was lower than that of healthy controls and this finding suggest that osteoporotic changes may be seen in younger ages. Further prospective studies are needed to better clarify the relationship between osteoporosis and schizophrenia.

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Osteoporosis in Patients With Schizophrenia

Cited by 107 publications

References 31 publications

Bone Remodeling, Bone Mass and Weight Gain in Patients with Stabilized Schizophrenia in Real-Life Conditions Treated with Long-Acting Injectable Risperidone

Bone Remodeling, Bone Mass and Weight Gain in Patients with Stabilized Schizophrenia in Real-Life Conditions Treated with Long-Acting Injectable Risperidone

Physical illness and schizophrenia: a review of the literature

Comparison of bone mineral density levels in young-adult patients with schizophrenia and healthy controls / Genç-erişkin şizofreni hastalarında kemik mineral yoğunluğu düzeyinin sağlıklı kontrollerle karşılaştırılması

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