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Effects of antipsychotics on bone mineral density and prolactin levels in patients with schizophrenia: a 12-month prospective study

2014; Wiley; Volume: 29; Issue: 2 Linguagem: Inglês

10.1002/hup.2387

1099-1077

Mengxin Wang, Ruihua Hou, Jian Jia, Guolin Mi, Hui-Min Qiu, Bingyu Cao, Tang Mao-qin,

Spondyloarthritis Studies and Treatments

Human Psychopharmacology: Clinical and ExperimentalVolume 29, Issue 2 p. 183-189 Research Article Effects of antipsychotics on bone mineral density and prolactin levels in patients with schizophrenia: a 12-month prospective study Mengxin Wang, Mengxin Wang Shandong University Qilu Hospital, Jinan, Shandong, ChinaSearch for more papers by this authorRuihua Hou, Ruihua Hou Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United KingdomSearch for more papers by this authorJia Jian, Jia Jian Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorGuolin Mi, Guolin Mi Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorHuimin Qiu, Huimin Qiu Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorBingyu Cao, Bingyu Cao Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorMaoqin Tang, Corresponding Author Maoqin Tang Shandong Mental Health Center, Jinan, Shandong, ChinaCorrespondence to: M. Tang, Department of Psychiatry, Shandong Mental Health Center, 49 Wenhua East Road, Jinan City, Shandong Province, China 250014. Tel: 0086-18764145579; Fax: 0086-531-88932855 E-mail: [email protected]Search for more papers by this author Mengxin Wang, Mengxin Wang Shandong University Qilu Hospital, Jinan, Shandong, ChinaSearch for more papers by this authorRuihua Hou, Ruihua Hou Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United KingdomSearch for more papers by this authorJia Jian, Jia Jian Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorGuolin Mi, Guolin Mi Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorHuimin Qiu, Huimin Qiu Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorBingyu Cao, Bingyu Cao Shandong Mental Health Center, Jinan, Shandong, ChinaSearch for more papers by this authorMaoqin Tang, Corresponding Author Maoqin Tang Shandong Mental Health Center, Jinan, Shandong, ChinaCorrespondence to: M. Tang, Department of Psychiatry, Shandong Mental Health Center, 49 Wenhua East Road, Jinan City, Shandong Province, China 250014. Tel: 0086-18764145579; Fax: 0086-531-88932855 E-mail: [email protected]Search for more papers by this author First published: 22 January 2014 https://doi.org/10.1002/hup.2387Citations: 33Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Objective Effects of conventional and atypical antipsychotics on bone mineral density (BMD) and serum prolactin levels (PRL) were examined in patients with schizophrenia. Methods One hundred and sixty-three first-episode inpatients with schizophrenia were recruited, to whom one of three conventional antipsychotics (perphenazine, sulpiride, and chlorpromazine) or one of three atypical antipsychotics (clozapine, quetiapine, and aripiprazole) was prescribed for 12 months as appropriate. BMD and PRL were tested before and after treatment. Same measures were conducted in 90 matched healthy controls. Results Baseline BMD of postero-anterior L1–L4 range from 1.04 ± 0.17 to 1.42 ± 1.23, and there was no significant difference between the patients group and healthy control group. However, post-treatment BMD values in patients (ranging from 1.02 ± 0.15 to 1.23 ± 0.10) were significantly lower than that in healthy controls (ranging from 1.15 ± 0.12 to 1.42 ± 1.36). The BMD values after conventional antipsychotics were significantly lower than that after atypical antipsychotics. The PRL level after conventional antipsychotics (53.05 ± 30.25 ng/ml) was significantly higher than that after atypical antipsychotics (32.81 ± 17.42 ng/ml). Conditioned relevance analysis revealed significant negative correlations between the PRL level and the BMD values after conventional antipsychotics. Conclusion The increase of PRL might be an important risk factor leading to a high prevalence of osteoporosis in patients with schizophrenia on long-term conventional antipsychotic medication. Copyright © 2014 John Wiley & Sons, Ltd. REFERENCES Alldredge BK, Kimble K, Anne M, Lloyd Y, Kradjan WA, Guglielmo BJ. 2009. Applied Therapeutics: The Clinical use of Drugs. Wolters Kluwer Health/Lippincott Williams & Wilkins: Philadelphia. Ataya K, Mercado A, Kartaginer J, Abbasi A, Moghissi KS. 1988. Bone density and reproductive hormones in patients with neuroleptic-induced hyperprolactinemia. Fertil Steril 50: 876–881. Bradford PG, Gerace KV, Roland RL, Chrzan BG. 2010. Estrogen regulation of apoptosis in osteoblasts. Physiol Behav 99: 181–185. Emiliano AB, Fudge JL. 2004. From galactorrhea to osteopenia: rethinking serotonin-prolactin interactions. Neuropsychopharmacology 29: 833–846. Goodman SB, Jiranek W, Petrow E, Yasko AW. 2007. The effects of medications on bone. J Am Acad Orthop Surg 15: 450–460. Graham SM, Howgate D, Anderson W, et al. 2011. Risk of osteoporosis and fracture incidence in patients on antipsychotic medication. Expert Opin Drug Saf 10: 575–602. Halbreich U. 2007. Osteoporosis, schizophrenia and antipsychotics: the need for a comprehensive multifactorial evaluation. CNS Drugs 21: 641–657. Halbreich U, Kahn LS. 2003. Hyperprolactinemia and schizophrenia: mechanisms and clinical aspects. J Psychiatr Pract 9: 344–353. Howard L, Kirkwood G, Leese M. 2007. Risk of hip fracture in patients with a history of schizophrenia. Br J Psychiatry 190: 129–134. Hummer M, Huber J. 2004. Hyperprolactinaemia and antipsychotic therapy in schizophrenia. Curr Med Res Opin 20: 189–197. Javaid MK, Holt RI. 2008. Understanding osteoporosis. J Psychopharmacol 22: 38–45. Kameda T, Mano H, Yuasa T, et al. 1997. Estrogen inhibits bone resorption by directly inducing apoptosis of the bone-resorbing osteoclasts. J Exp Med 186: 489–495. Kaneda Y, Kawamura I, Fujii A, Ohmori T. 2004. Impact of a switch from typical to atypical antipsychotic drugs on quality of life and gonadal hormones in male patients with schizophrenia. Neuro Endocrinol Lett 25: 135–140. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N. 2008. A reference standard for the description of osteoporosis. Bone 42: 467–475. Kay SR, Opler LA, Lindenmayer JP. 1988. Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Res 23: 99–110. Kishimoto T, Watanabe K, Takeuchi H, et al. 2005. Bone mineral density measurement in female inpatients with schizophrenia. Schizophr Res 77: 113–115 Krum SA, Brown M. 2008. Unraveling estrogen action in osteoporosis. Cell Cycle 7: 1348–1352. Lee TY, Chung MY, Chung HK, Choi JH, Kim TY, So HS. 2010. Bone density in chronic schizophrenia with long-term antipsychotic treatment: preliminary study. Psychiatry Investig 7: 278–284. Lieberman JA, Stroup TS, McEvoy JP. 2005. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353: 1209–1223. McGrath J, Saha S, Chant D, Welham J. 2008. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 30: 67–76. Meaney AM, Smith S, Howes OD, O'Brien M, Murray RM, O'Keane V. 2004. Effects of long-term prolactin-raising antipsychotic medication on bone mineral density in patients with schizophrenia. Br J Psychiatry 184: 503–508. Molitch ME. 2005. Medication-induced hyperprolactinemia. Mayo Clin Proc 80: 1050–1057. Montejo AL. 2008. Prolactin awareness: an essential consideration for physical health in schizophrenia. Eur Neuropsychopharmacol 18: S108–S114. Montgomery J, Winterbottom E, Jessani M, et al. 2004. Prevalence of hyperprolactinemia in schizophrenia: association with typical and atypical antipsychotic treatment. J Clin Psychiatry 65: 1491–1498. Partti K, Heliövaara M, Impivaara O, et al. 2010. Skeletal status in psychotic disorders: a population-based study. Psychosom Med 72: 933–940. Petty RG. 1999. Prolactin and antipsychotic medications: mechanism of action. Schizophr Res 35: S67–S73. Peveler RC, Branford D, Citrome L, et al. 2008. Antipsychotics and hyperprolactinaemia: clinical recommendations. J Psychopharmacol 22: 98–103. Renn JH, Yang NP, Chueh CM, Lin CY, Lan TH, Chou P. 2009. Bone mass in schizophrenia and normal populations across different decades of life. BMC Musculoskelet Disord 10: 1. Renn JH, Yang NP, Chou P. 2010. Effects of plasma magnesium and prolactin on quantitative ultrasound measurements of heel bone among schizophrenic patients. BMC Musculoskelet Disord 11: 35. Rey-Sánchez P, Lavado-García JM, Canal-Macías ML, Gómez-Zubeldia MA, Roncero-Martín R, Pedrera- Zamorano JD. 2009. Ultrasound bone mass in schizophrenic patients on antipsychotic therapy. Hum Psychopharmacol 24: 49–54. Riecher-Rössler A, Schmid C, Bleuer S, Birkhäuser M. 2009. Antipsychotics and hyperpolactinaemia: pathophysiology, clinical relevance, diagnosis and therapy. Neuropsychiatr 23: 71–83. Roke Y, van Harten PN, Boot AM, Buitelaar JK. 2009. Antipsychotic medication in children and adolescents: a descriptive review of the effects on prolactin level and associated side effects. J Child Adolesc Psychopharmacol 19: 403–414. Sugawara N, Yasui-Furukori N, Fujii A, et al. 2011. No association between bone mass and prolactin levels among patients with schizophrenia. Hum Psychopharmacol 26: 596–601. Van Os J, Kapur S. 2009. Schizophrenia. Lancet 374: 635–645. Wahlbeck K, Tuunainen A, Ahokas A, Leucht S. 2001. Dropout rates in randomized antipsychotic drug trials. Psychopharmacology (Berl) 155: 230–233. Walters J, Jones I. 2008. Clinical questions and uncertainty-prolactin measurement in patients with schizophrenia and bipolar disorder. J Psychopharmacol 22: 82–89. World Health Organization. 1994. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of WHO Study Group. World Health Organization. 2004. World Health Organization scientific group on the assessment of osteoporosis at the primary health care level. Summary Meeting Report. Brussels. World Health Organization. 2011. Schizophrenia. Available at: (http://www.who.int/mental_health/management/schizophrenia/en/) Assessed 26 February 2013 Citing Literature Volume29, Issue2March 2014Pages 183-189 ReferencesRelatedInformation