The Impact of Psychotropic Medications on Bone Health in Youth

Rice, Jessie; Gillett, Carrie B.; Malas, Nasuh

doi:10.1007/s11920-018-0960-5

Cited by 14 publications

(38 citation statements)

References 100 publications

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“…Proposed mechanism: Serotonin impact on osteoclast activity. 56 Application to practice: Consider vitamin D supplementation particularly in setting of other risk factors and/or vitamin D insufficiency/deficiency. Obtain vitamin D level at baseline and if supplementing.…”

Section: Antidepressantsmentioning

confidence: 99%

Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Stutzman¹

2021

Mental Health Clinician

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It is estimated that 8% to 12% of youth are prescribed psychotropic medications. Those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities are more likely to be prescribed high-risk regimens. The use of psychotropic medications in this age group is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. Overall, there is a lack of literature describing the long-term use of psychotropic medications in youth—particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry, given concerns for over-prescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.

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Section: Antidepressantsmentioning

confidence: 99%

Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Stutzman¹

2021

Mental Health Clinician

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“…Benzodiazepines have also been shown to decrease osteoblast differentiation through benzodiazepine-like receptors. BMD may also be reduced as a result of benzodiazepine treatment, and their use has been associated with increased ALP, reduced serum levels of vitamin D [reviewed in Fan et al (198)], and increased levels of prolactin, which, in turn, results in decreased estrogen (199). These studies strongly suggest that benzodiazepines be prescribed with caution among those at risk for development of osteoporosis, and lifestyle modifications and supplementation as adjunctive therapies warrant consideration in these patients.…”

Section: Interaction Of Treatmentsmentioning

confidence: 99%

Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions

et al. 2019

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The significant biochemical and physiological effects of psychological stress are beginning to be recognized as exacerbating common diseases, including osteoporosis. This review discusses the current evidence for psychological stress-associated mental health disorders as risk factors for osteoporosis, the mechanisms that may link these conditions, and potential implications for treatment. Traditional, alternative, and adjunctive therapies are discussed. This review is not intended to provide therapeutic recommendations, but, rather, the goal of this review is to delineate potential interactions of psychological stress and osteoporosis and to highlight potential multi-system implications of pharmacological interventions. Review of the current literature identifies several potentially overlapping mechanistic pathways that may be of interest (e.g., glucocorticoid signaling, insulin-like growth factor signaling, serotonin signaling) for further basic and clinical research. Current literature also supports the potential for cross-effects of therapeutics for osteoporosis and mental health disorders. While studies examining a direct link between osteoporosis and chronic psychological stress are limited, the studies reviewed herein suggest that a multi-factorial, personalized approach should be considered for improved patient outcomes in populations experiencing psychological stress, particularly those at high-risk for development of osteoporosis.

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“…A series of case reports of presumed serotonin syndrome in children receiving multiple concurrent psychotropics including SSRIs, stimulants, and atypical antipsychotics underscores the risk of serotonin toxicity when prescribing multiple medications ( 11 – 13 ). There is emerging evidence that many classes of psychotropic medications can have a negative impact on pediatric bone health and increase the risk for osteoporosis ( 14 ). The most evidence exists for anticonvulsant mood stabilizers prompting recommendations for routine baseline and monitoring of vitamin D levels for all children on anticonvulsants and vitamin D supplementations for those on chronic mood stabilizers ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…The most evidence exists for anticonvulsant mood stabilizers prompting recommendations for routine baseline and monitoring of vitamin D levels for all children on anticonvulsants and vitamin D supplementations for those on chronic mood stabilizers ( 15 ). As atypical antipsychotics and SSRIs can increase prolactin levels through different mechanisms, it is important to monitor bone health for children prescribed combinations of antipsychotics, mood stabilizers and SSRIs ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…There is emerging evidence that many classes of psychotropic medications can have a negative impact on pediatric bone health and increase the risk for osteoporosis (14). The most evidence exists for anticonvulsant mood stabilizers prompting recommendations for routine baseline and monitoring of vitamin D levels for all children on anticonvulsants and vitamin D supplementations for those on chronic mood stabilizers (15).…”

mentioning

confidence: 99%

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Inter-class Concomitant Pharmacotherapy in Medicaid-Insured Youth Receiving Psychiatric Residential Treatment

et al. 2021

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Background: Concomitant pharmacotherapy has become increasingly common in the treatment of youth, including in psychiatric residential treatment facilities (PRTF) despite limited efficacy and safety data. Research is reported on the prevalence of any class and interclass concomitant pharmacotherapy, specific class combinations of psychotropics, and changes in number of medications from admission to discharge for Medicaid insured youth treated in PRTFs in one mid—Atlantic state.Methods: Medicaid administrative claims data were examined for youth under age 18 years who were discharged from one of 21 PRTFs during calendar year 2019. Descriptive statistics were calculated to examine patterns of service utilization 90 days prior to admission. The rates of concomitant psychotropic use at admission were compared to the rates at discharge. Logistic regression models were used to examine covariates associated with discharging on 4 or more medications.Results: Fifty-four % of youth were admitted on either two or three psychotropics, while 25% were admitted on four or more psychotropics. The proportion of youth admitting and discharging on 2 or 3 medications was stable. There was a 27% increase in number of youth discharging on 4 medications with a 24% decrease in those on a 5- drug regimen. Only the number of medications prescribed at admission was found to be significant (p < 0.001), with more medications at admission contributing to probability of discharging on 4 or more medications.Conclusions: Concomitant pharmacotherapy is common in PRTFs. These findings support the practice of deprescribing and underscore the need for further research.

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The Impact of Psychotropic Medications on Bone Health in Youth

Cited by 14 publications

References 100 publications

Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions

Inter-class Concomitant Pharmacotherapy in Medicaid-Insured Youth Receiving Psychiatric Residential Treatment

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