Use of antipsychotic medication and its relationship with bone mineral density: A population-based study of men and women

Abstract

BackgroundSchizophrenia has been shown to be associated with reduced bone mineral density (BMD) and higher fracture risk. However, less is known whether antipsychotic treatment is associated with reduced BMD. Thus, we aimed to examine associations between antipsychotic use and BMD among men and women drawn from the general population.MethodsThis cross-sectional study involved 793 women and 587 men enrolled in the Geelong Osteoporosis Study (GOS). BMD was determined using dual-energy X-ray absorptiometry at the spine and hip. Information regarding socio-economic status (SES), current medication and/or supplementation use, lifestyle factors, and anthropometry was collected. Association between antipsychotic use and BMD was determined using linear regression after adjusting for potential confounders.ResultsOf the group, 33 women (4.2%) and 16 men (2.7%) currently used antipsychotics. Age was identified as an effect modifier in the association between antipsychotic use and BMD for women. Amongst women aged < 60 years, adjusted mean BMD was 11.1% lower at the spine [1.139 (95%CI 1.063–1.216) vs. 1.250 (95%CI 1.223–1.277) g/cm2, p = 0.005] for antipsychotic users compared to non-users. At the hip, age, weight, and smoking adjusted mean BMD was 9.9% lower [0.893 (95%CI 0.837–0.950) vs. 0.992 (95%CI 0.976–1.007) g/cm2, p < 0.001] for antipsychotic users in comparison with non-users. The pattern persisted following further adjustments. There was no association detected between antipsychotic use and BMD for women aged 60 years and over and for men.ConclusionOur data suggest that antipsychotic medication use is associated with reduced BMD in younger women but not older women or men.

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

“…Data taken from ( 34 , 64 , 140 – 142 , 147 – 184 ). Binding affinity for receptors: + = week association (Ki value 100–1,000); ++ = Moderate association ( 10 – 91 ); +++ = strong association ( Howes et al, 2009 ; De Hert et al, 2011 ; Patel et al, 2014 ; Fraser et al, 2015 ; Lally and MacCabe, 2015 ; Hálfdánarson et al, 2017 ; Haddad and Correll, 2018 ; Wang et al, 2021a ; Australian Institute of Health and Welfare, 2022 ; Azimi Manavi et al, 2023 ); ++++ = very strong association (Ki < 1); ? = unknown.…”

“…There is a growing body of evidence to show that schizophrenia is associated with osteoporosis, a degenerative bone disease characterised by low BMD and increased fracture risk ( Jung et al, 2011 ; Lally, 2020 ; Forns et al, 2021 ; Azimi Manavi et al, 2023 ). The onset of schizophrenia occurs primarily in adolescents and young adults, where peak bone mass is yet to be achieved ( Forns et al, 2021 ; Zhu and Zheng, 2021 ).…”

“…Global statistics has shown that schizophrenia is the eighth leading cause of disability in people aged 15–44 years ( Haddad and Correll, 2018 ). Antipsychotics are also used off-label in the treatment of anxiety, borderline personality disorder, substance use disorders, eating disorders, post-traumatic stress disorder, obsessive-compulsive disorder, mood disorders, insomnia, agitation and attention deficit hyperactivity disorder ( Wang et al, 2021a ; Azimi Manavi et al, 2023 ). Between 2005–2014, the prescription rate of antipsychotic use overall has increased in 10 out of 16 countries, with the atypical antipsychotics, quetiapine, olanzapine and risperidone being most prescribed ( Hálfdánarson et al, 2017 ).…”

“…The use of antipsychotics is associated with a number of side effects including tardive dyskinesia (repetitive, involuntary movements commonly in areas of the face, eyes, and mouth), dystonia (involuntary muscle movements that can affect the head, face, and neck), akathisia (inability to remain still), weight gain, hyperglycaemia, type 2 diabetes and adverse cardiovascular impacts including sudden cardiac death ( De Hert et al, 2011 ). There is a growing body of evidence suggesting that antipsychotics are also associated with negative, off-target side effects that include reductions in bone mineral density (BMD) and increased fracture risk ( Kishimoto et al, 2008 ; Crews and Howes, 2012 ; Fraser et al, 2015 ; Bolton et al, 2017 ; May et al, 2019 ; Paschou et al, 2019 ; Azimi Manavi et al, 2023 ). The mechanism(s) by which antipsychotics induce bone loss are yet to be fully explored and understood.…”

Antipsychotic medication use in association with quantitative heel ultrasound (QUS)

“…Common side effects of antipsychotic use include weight gain, diabetes, cognitive impairment, falls and sedation ( Stroup and Gray, 2018 ). More recently, antipsychotic use has been associated with reduced bone mineral density ( BMD ) and an increased risk of osteoporosis and subsequent fracture ( Graham et al, 2011 ; Azimi Manavi et al, 2023 ).…”