In this article, we will discuss psychotropic drugs and osteoporosis.
In recent years, more and more people are being treated for psychosis, and the literature presented discusses the relationship between medication and osteoporosis.
Summary
In Western countries, more than 15% of the adult population is said to suffer from mental disorders, and psychotropic drugs are among the most highly prescribed medications.
In particular, antipsychotic drugs used to treat psychosis, related to schizophrenia and bipolar disorder, may be prescribed in a wide variety of settings.
The prescriptions are often used for children and the elderly.
They are prescribed and taken despite clinical evidence of increased risk of osteoporosis and fractures, and antipsychotic treatment has also been associated with increased risk of obesity, dyslipidemia, and type 2 diabetes.
Many patients taking antipsychotics have risk factors for osteoporosis, such as smoking, extreme BMI (too low or too high), poor nutrition, low levels of physical activity, high levels of alcohol consumption, or vitamin D deficiency.
In addition, genetic predisposition, mild inflammation, and elevated cytokine levels in schizophrenic patients may affect bone strength and quality.
Research
Evidence of a significant association between schizophrenia and osteoporotic fractures (MOF) came from the following
A large longitudinal cohort drawn from a Canadian population-based registry of 68,730 people found that antipsychotic medications were associated with both MOF and hip fractures.In a concurrent analysis of mental illness and substance use, only substance use was associated with fracture.
Interestingly, the FRAX score underestimated the 10-year risk of hip fracture by 171% in patients who used antipsychotics.
Other cross-sectional and longitudinal studies and meta-analyses have also shown that antipsychotic use is associated with lower BMD and increased fracture risk.
Gender-specific risk is shown to be increased in both.
When 120 patients with first-episode schizophrenia were treated with clozapine, quetiapine or aripiprazole and compared to healthy controls 12 months after drug initiation, BMD was found to be significantly lower in all drug categories.
In addition, in the pediatric population, antipsychotics increased the risk of fracture two- to threefold, which was associated with decreased bone mass.
Physiology
Possible pathophysiological mechanisms of bone health problems after antipsychotic use include alterations in dopaminergic or serotonergic signaling pathways.
Since these drugs are distributed to the bone marrow and brain, drug-induced fractures may be due to both centrally mediated effects and direct effects on bone metabolic turnover.
A common hypothesis is that antipsychotic drugs affect BMD and increase the risk of fracture due to hyperprolactinemia.
In fact, antipsychotics have caused hyperprolactinemia in women, men and children.
It is well known that subsequent hypogonadism leads to bone loss.
In addition to hypogonadism, hyperprolactinemia can have a direct impact on bone tissue and the rate of bone metabolism.
In fact, elevated prolactin levels are associated with increased bone resorption and bone formation, and since bone metabolic turnover is also regulated by the sympathetic nervous system, possible dysregulation of sympathetic output to bone may also be involved in antipsychotic-induced bone loss.
Furthermore, dopamine is present in bone marrow and inhibits osteoclastogenesis and osteoblastogenesis.The effects of dopamine antagonists on these molecular procedures may be responsible for the increased risk of osteoporosis in patients receiving these medications.
Paschou SA, Mentzelopoulos P, Lambrinoudaki I. Antipsychotic therapies and bone health. Case Rep Womens Health. 2019;25:e00160. Published 2019 Nov 19 . doi:10.1016/j.crwh.2019.e00160
Conclusion.
Chronic use of antipsychotic drugs represents a risk factor for osteoporosis and fractures.
Antipsychotic-induced fractures appear to be the result of both centrally mediated effects and direct effects on bone metabolic turnover.
Given the increasing number of patients being prescribed these medications, it is important to understand the risks and underlying mechanisms, and physicians treating patients need to account for these effects on bone health in their prescribing, patient monitoring, and prevention practices.
