Comparison of bone mineral density levels in young-adult patients with schizophrenia and healthy controls

Amaç: Bu çalışmanın amacı, genç-erişkin şizofreni hastalarında kemik mineral yoğunluğunun değerlendirilmesi ve sağlıklı kontrollerle karşılaştırılmasıdır. Yöntem: Bu kesitsel çalışmaya, yaşları 22 ve 44 arasında değişen 14 şizofreni hastası ve kontrol grubu olarak, 31 sağlıklı birey dahil edildi. Her iki grubun kemik mineral yoğunluğu ölçümü Dual Energy X-ray Absorbiometry (DEXA) ile yapıldı. Hastalar, Pozitif ve Negatif Semptom Ölçeği (PANSS) ile değerlendirildi. Hastaların tamamı, en az 2 yıldır şizofreni tanısı ile antipsikotik kullanmaktaydı. Hastaların sosyodemografik özellikleri ve osteopo roz için risk faktörleri (antipsikotik kullanımı, güneş ışınlarına maruziyet, fiziksel aktivite, vs.) sorgulanarak kemik mineral yoğunluğu ile ilişkisi araştırıldı. Bulgular: Sağlıklı kontrollerle karşılaştırıldığında, şizofreni hastalarında, hem lomber omurgada hem de proksi mal femurun tüm bölgelerinde kemik mineral yoğunluğu daha düşüktü. Bağıntı analizi sonucunda, şizofreni hastalarında, yalnızca femur bölgesindeki kemik mineral yoğunluğu ile ilişkili tek faktör olarak yaş bulundu. Kemik mineral yoğunluğu ile cinsiyetin, PANSS skorlarının, kullanılan antipsikotik türünün ve osteoporoz için risk faktörü olan diğer etkenlerin ilişkisi olmadığı tespit edildi. Sonuç: Bu çalışmada şizofreni hastalarının kemik mineral yoğunluğunun, sağlıklı bireylere göre daha düşük bulunması, şizofreni olgularında genç yaşta osteoporotik değişikliklerin olabileceğini düşündürmektedir. Şizofreni ve osteoporoz arasındaki ilişkiyi daha iyi açığa çıkaracak prospektif çalışmalara ihtiyaç vardır.

Genç-erişkin şizofreni hastalarında kemik mineral yoğunluğu düzeyinin sağlıklı kontrollerle karşılaştırılması

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.

PDF

___

1. Johnston CC, Melton LJ, Lindsdy R. Clinical indications for bone mass measurements: report of the Scientific Advisory Committee of the National Osteoporosis Foundation. J Bone Miner Res 1989; 4 (Suppl.2):1-28.
2. Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clin Orthop Relat Res 1990; 252:163- 166.
3. Glaser DL, Kaplan FS. Osteoporosis: definition and clinical presentation. Spine 1997; 22 (Suppl.24):12-16.
4. Cummings SR, Kelsey JL, Nevitt MC, Cummings SR. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985; 135:178-208.
5. Seman E, Melton LJ 3rd, O’Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med 1983; 75:977-983.
6. Lindholm J, Steiniche T, Rasmussen E, Thamsborg G, Nielsen IO, Brockstedt-Rasmussen H, Storm T, Hyldstrup L, Schou C. Bone disorder in men with chronic alcoholism: a reversible disease? J Clin Endocrinol Metab 1991; 73:118-124.
7. Hahn TJ, Boisseau WV, Avioli LV. Effect of chronic corticosteroid administration on diaphyseal and metaphyseal bone mass. J Clin Endocrinol Metab 1974; 39:274-281.
8. Halbreich U, Rojansky N, Palter S, Hreshchyshyn M, Kreeger J, Bakhai Y, Rosan R. Decreased bone mineral density in medicated psychiatric patients. Psychosom Med 1995; 57:485-491.
9. Levinson DF, Simpson GM. Antipsychotic drug side effects. Psychiatry Update: APA Annual Review, Vol 6. Washington, DC: American Psychiatric Association, 1987, 704-723.
10. Papaioannou A, Kennedy CC, Cranney A, Hawker G, Brown JP, Kaiser SM, Leslie WD, O’Brien CJ, Sawka AM, Khan A, Siminoski K, Tarulli G, Webster D, McGowan J, Adachi JD. Risk factors for low BMD in healthy men age 50 years or older: a systematic review. Osteoporos Int 2009; 20:507-518.
11. DeLeon J, Verghese C, Tracy JI, Josiassen RC, Simpson GM. Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biol Psychiatry 1994; 35:408-419.
12. Kavanagh DJ, McGrath J, Saunders JB, Dore G, Clark D. Substance misuse in patients with schizophrenia: epidemiology and management. Drugs 2002; 62:743-755.
13. Cantor-Graae E, Nordstrom LG, McNeil TF. Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophr Res 2001; 48:69-82.
14. Halbreich U, Palter S. Accelerated osteoporosis in psychiatric patients: possible pathophysiological processes. Schizophr Bull 1996; 22:447-454.
15. Abraham G, Friedman RH, Verghese C, de Leon J. Osteoporosis and schizophrenia: can we limit known risk factors? Biol Psychiatry 1995; 38:131-132.
16. Hummer M, Malik P, Gasser RW, Hofer A, Kemmler G, Moncayo Naveda RC, Rettenbacher MA, Fleischhacker WW. Osteoporosis in patients with schizophrenia. Am J Psychiatry 2005; 162:162-167.
17. Delezé M, Cons-Molina F, Villa AR, Morales-Torres J, Gonzalez- Gonzalez JG, Calva JJ, Murillo A, Briceño A, Orozco J, Morales- Franco G, Peña-Rios H, Guerrero-Yeo G, Aguirre E, Elizondo J. Geographic differences in bone mineral density of Mexican women. Osteoporos Int 2000; 11:562-569.
18. Altındağ Ö, Altındağ A, Vınt O, Savaş H, Yılmaz M, Bozgeyik Ö, Aydeniz A, Gürsoy S. Bone mineral density in schizophrenia patients on antipsychotics. Bulletin of Clinical Psychopharmacology 2009; 19:402-406.
19. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13:261-275.
20. Kostakoglu AE, Batur S, Tiryaki A. Pozitif ve negatif sendrom ölçeginin (PANSS) Türkçe uyarlamasının geçerlilik ve güvenilirliği. Türk Psikoloji Dergisi 1999; 14:23-32 (Article in Turkish).
21. Cummings SR, Bates D, Black DM. Clinical use of bone densitometry. JAMA 2002; 288:1889-1897.
22. Keely EJ, Reiss JP, Drinkwater DT, Faiman C. Bone mineral density, sex hormones, and long-term use of neuroleptic agents in men. Endocr Pract 1997; 3:209-213.
23. Delva NJ, Crammer JL, Jarzylo SV, Lawson JS, Owen JA, Sribney M, Weir BJ, Yendt ER. Osteopenia, pathological fractures, and increased urinary calcium excretion in schizophrenic patients with polydipsia. Biol Psychiatry 1989; 26:781-793.
24. Rojansky N, Halbreich U, Rosan R, Wang K, Hreshchyshyn M. Hormonally-related osteoporosis in chronic psychiatric patients. Neuroendocrin Letters 1990; 12:304.
25. Naidoo U, Goff DC, Klibanski A. Hyperprolactinemia and bone mineral density: the potential impact of antipsychotic agents. Psychoneuroendocrinology 2003; 28:97-108.
26. Karakuş G, Tamam L, Zengin M. Şizofreni hastalarında antipsikotik kullanımına bağlı hiperprolaktinemi ve kemik metabolizma bozuklukları. Anadolu Psikiyatri Dergisi 2009; 10:336-342 (Article in Turkish).
27. Ataya K, Mercado A, Kartaginer J, Abbasi A, Moghissi KS. Bone density and reproductive hormones in patients with neuroleptic- induced hyperprolactinemia. Fertil Steril 1988; 50:876-881.
28. O’Keane V. Antipsychotic-induced hyperprolactinaemia, hypogonadism and osteoporosis in the treatment of schizophrenia. J Psychopharmacol 2008; 22:70-75.
29. Graham SM, Howgate D, Anderson W, Howes C, Heliotis M, Athanassios M, Tsiridis E, Tsapakis E. Risk of osteoporosis and fracture incidence in patients on antipsychotic medication. Expert Opin Drug Saf 2011; 10:575-602.
30. Renn JH, Yang NP, Chueh CM, Lin CY, Lan TH, Chou P. Bone mass in schizophrenia and normal populations across different decades of life. BMC Musculoskelet Disord 2009; 10:1.
31. Bergemann N, Auler B, Parzer P, Resch F, Mundt C, Ziegler R, Seibel M. High bone turnover but normal bone mineral density in women with schizophrenia (abstract). Bone 2001; 28:248.
32. Häfner H, Maurer K, Loffler W, Fatkenheuer B, An der Heiden W, Riecher-Rössler A, Behrens S, Gattaz WF. The epidemiology of early schizophrenia: influence of age and gender on onset and early course. Br J Psychiatry 1994; 23:29-38.
33. Becker D, Liver O, Mester R, Rapoport M, Weizman A, Weiss M. Risperidone, but not olanzapine, decreases bone mineral density in female premenopausal schizophrenia patients. J Clin Psychiatry 2003; 64:761-766.
34. Bilici M, Cakirbay H, Guler M, Tosun M, Ulgen M, Tan U. Classical and atypical neuroleptics, and bone mineral density, in patients with schizophrenia. Int J Neurosci 2002; 112:817-828.
35. Byerly M, Suppes T, Tran QV, Baker RA. Clinical implications of antipsychotic-induced hyperprolactinemia in patients with schizophrenia spectrum or bipolar spectrum disorders: recent developments and current perspectives. J Clin Psychopharmacol 2007; 27:639-661.
36. Kishimoto T, Watanabe K, Shimada N, Makita K, Yagi G, Kashima H. Antipsychotic-induced hyperprolactinemia inhibits the hypothalamo–pituitary–gonadal axis and reduces bone mineral density in male patients with schizophrenia. J Clin Psychiatry 2008; 69:385-391.
37. Lee TY, Chung MY, Chung HK, Choi JH, Kim TY, So HS. Bone density in chronic schizophrenia with long-term antipsychotic treatment: preliminary study. Psychiatry Investig 2010; 7:278-284.
38. Sherman S. Preventing and treating osteoporosis: strategies at the millennium. Ann N Y Acad Sci 2001; 949:188-197.