Bone mineral density in patients treated with antipsychotics

Objective: The aim of this study was to investigate the effect of prolactin levels, duration of disease, accompanying metabolic syndrome, use of mood stabilizer drugs, smoking and exercise on bone mineral density (BMD) in patients treated with antipsychotics. Methods: Fifty-six patients who had been diagnosed with schizophrenia, forty-one patients who had been diagnosed with schizoaffective disorder and thirty three patients who had been diagnosed with bipolar disorders were included the study. BMD was measured at the lumbar spine and femoral sites using dual energy x-ray absorptiometry (DEXA). Arterial blood pressure, waist circumference, fasting glucose, HDL cholesterol and triglyceride levels of the patients were measured for diagnosis of metabolic syndrome. The age, weight, height, smoking habits, regular physical exercise, additional mood stabilizer drugs administered and blood prolactin levels were recorded. Results: Results of 73 patients were osteopenia or osteoporosis. There was no statistically significant relationship between BMD and plasma prolactin level, using additional mood stabilizer drugs, dose of antipsychotic drugs and metabolic syndrome. There was negative correlation between duration of illness, duration of antipsychotic drug use and BMD of the femoral neck. There was negative correlation between duration of smoking and BMD of femoral intertrochanteric region. Lumbar BMD was significantly higher in patients exercising regularly than those of patients without regular physical exercise. Conclusion: Due to a sedantary lifestyle, pro- longed use of antipsychotic drugs and smoking risk of osteoporosis increases in patients with schizophrenia, schizo- affective disorder and bipolar disorder. BMD of these patients should be followed-up with regular intervals. (Ana- tolian Journal of Psychiatry 2019; 20(2):182-188)

Antipsikotiklerle tedavi edilen hastalarda kemik mineral yoğunluğu

Amaç: Bu çalışmanın amacı, antipsikotik ile tedavi edilen hastalarda prolaktin düzeyi, hastalık süresi, eşlik eden metabolik sendrom, duygudurum düzenleyici kullanımı, sigara içme ve egzersizin kemik mineral yoğunluğu üzerine etkisini araştırmaktır. Yöntem: Çalışmaya 56 şizofreni hastası, 41 şizoaffektif bozukluk hastası, 33 bipolar bozukluk hastası alınmıştır. Kemik mineral yoğunluğu (KMY) ölçümü lomber vertebra ve femurdan dual enerji X-ray absorp- siyometri (DEXA) kullanılarak ölçüldü. Metabolik sendrom tanısı için hastaların arteriyal kan basıncı, bel çevresi, açlık kan şekeri, HDL kolesterol ve trigliserid düzeyi ölçümleri yapıldı. Yaş, ağırlık, boy, sigara alışkanlığı, düzenli fiziksel egzersiz alışkanlığı, ek duygudurum düzenleyici kullanımı ve kan prolaktin düzeyleri kayıt edildi. Bulgular: Yetmiş üç hastanın sonucu osteopeni veya osteoporoz idi. KMY ile serum prolaktin düzeyi, ek duygudurum düzen- leyici kullanımı, antipsikotik ilaç dozu ve metabolik sendrom arasında istatistiksel olarak anlamlı ilişki yoktu. Hastalık süresi ve antipsikotik ilaç kullanım süresi ile femur boyun KMY arasında negative korelasyon saptandı. Sigara içme süresi ile femur intertorakanterik bölge KMY arasında negatif korelasyon saptandı. Düzenli egzersiz yapan hasta- larda lomber KMY yoğunluğu düzenli egzersiz yapmayanlardan anlamlı olarak yüksekti. Sonuç: Sedanter yaşam

___

Takahashi T, Uchida H, John M, Hirano J, Wata- nabe K, Mimura M, et al. The impact of prolactin- raising antipsychotics on bone mineral density in patients with schizophrenia: findings from a longitudinal observational cohort. Schizophr Res 2013; 147:383-386.

Stubbs B, Gaughran F, Mitchell AJ, De Hert M, Farmer R, Soundy A, et al. Schizophrenia and the risk of fractures: a systematic review and compar- ative meta-analysis. Gen Hosp Psychiatry 2015; 37:126-133.

Stubbs B, De Hert M, Sepehry AA, Correll CU, Mitchell AJ, Soundy A, et al. A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia. Acta Psychiatr Scand 2014; 130:470-486.

Yang J, Joe SH, Lee MS, Ko YH, Jung IK, Kim SH. Effects of long-term combination treatment with valproate and atypical antipsychotics on bone mineral density and bone metabolism in premeno- pausal patients with bipolar disorder: a preliminar- y study. Psychiatry Investig 2011; 8(3):256-261.

Chen CY, Lane HY, Lin CH. effects of antipsycho- tics on bone mineral density in patients with schi- zophrenia: gender differences. Clin Psychophar- macol Neurosci 2016; 31;14(3):238-249.

Crews MP, Howes OD. Is antipsychotic treatment linked to low bone mineral density and osteo- porosis? A review of the evidence and the clinical implications. Hum Psychopharmacol 2012; 27:15- 23.

Halbreich U. Osteoporosis, schizophrenia and antipsychotics: the need for a comprehensive multifactorial evaluation. CNS Drugs 2007; 21:641-657.

Howes OD, Wheeler MJ, Meaney AM, O'Keane V, Fogelman I, Blake G, et al. Bone mineral density and its relationship to prolactin levels in patients taking antipsychotic treatment. J Clin Psycho- pharmacol 2005; 25:259-261.

Halbreich U, Palter S. Accelerated osteoporosis in psychiatric patients: possible pathophysiological processes. Schizophr Bull 1996; 22:447-454.

Kavanagh DJ, McGrath J, Saunders JB, Dore G, Clark D. Substance misuse in patients with schizophrenia: epidemiology and management. Drugs 2002; 62:743-755.

Misra M, Papakostas GI, Klibanski A. Effects of psychiatric disorders and psychotropic medica- tions on prolactin and bone metabolism. J Clin Psychiatry 2004; 65:1607-1618.

Malhotra N, Grover S, Chakrabarti S, Kulhara P. Metabolic syndrome in schizophrenia. Indian J Psychol Med 2013; 35:227-240.

De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteo- poros Int 2005; 16:1330-1338.

Jankowska EA, Rogucka E, MedraśM. Are gener- al obesity and visceral adiposity in men linked to reduced bone mineral content resulting from normal ageing? A population-based study. Andro- logia 2001; 33:384-389.

Park KK, Kim SJ, Moon ES. Association between bone mineral density and metabolic syndrome in postmenopausal Korean women. Gynecol Obstet Invest 2010; 69:145-152.

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung and Blood Institute Scientific Statement. Execu- tive Summary Cardiol Rev 2005; 13:322-327.

Wold Health Organization Guidelines for Precli- nical Evaluation and Clinical Trials in Osteo- porosis. Geneva: WHO, 1998, p.5-6.

Howes OD, Wheeler MJ, Pilowsky LS, Landau S, Murray RM, Smith S. Sexual function and gonadal hormones in patients taking antipsychotic treat- ment for schizophrenia or schizoaffective disor- der. J Clin Psychiatry 2007; 68:361-367.

Meaney AM, O’Keane V. Prolactin and schizo- phrenia: clinical consequences of hyperprolac- tinemia. Life Sci 2002; 71:979-992.

Howes OD, Wheeler MJ, Meaney AM, O'Keane V, Fogelman I, Blake G, et al. Bone mineral density and its relationship to prolactin levels in patients taking antipsychotic treatment. J Clin Psychophar- macol 2005; 25:259-261.

O'Keane V. Antipsychotic-induced hyperprolac- tinaemia, hypogonadism and osteoporosis in the treatment of schizophrenia. J Psychopharmacol 2008; 22:70-75.

Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int 2005; 16155-16162.

Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2011; 6;(7).

Babić D, Maslov B, Martinac M, Nikolić K, Uzun S, Kozumplik O. Bipolar disorder and metabolic syn- drome: comorbidity or side effects of treatment of bipolar disorder. Psychiatr Danub 2010; 22:75-78.

Zhou J, Zhang Q, Yuan X, Wang J, Li C, Sheng H, et al. Association between metabolic syndrome and osteoporosis: a meta-analysis. Bone 2013; 57:30-35.

Jeon YK, Lee JG, Kim SS, Kim BH, Kim SJ, Kim YK, et al. Association between bone mineral den- sity and metabolic syndrome in pre- and post- menopausal women. Endocr J 2011; 58:87-93.

Nakamura K, Saito T, Kobayashi R, Oshiki R, Oyama M, Nishiwaki T, et al. C-reactive protein predicts incident fracture in community-dwelling elderly Japanese women: the Muramatsu Study. Osteoporos Int 2011;22: 2145-2150.