Psychosomatic Medicine, Vol 57, Issue 5 485-491, Copyright © 1995 by American Psychosomatic Society

ORIGINAL ARTICLES

Decreased bone mineral density in medicated psychiatric patients

U Halbreich, N Rojansky, S Palter, M Hreshchyshyn, J Kreeger, Y Bakhai and R Rosan
Biobehavioral Program, State University of New York at Buffalo 14215, USA.

Osteoporosis is a common problem in postmenopausal women. It has been linked to estrogen deficiency, other neuroendocrine processes such as hypercortisolemia and male hypogonadism, nutritional deficiencies, and other mechanisms. Some of these changes have been also reported in male and female patients with mental disorders, especially those receiving psychotropic medications. Therefore, bone mineral density was measured by dual-photon absorptiometry in the lumbar spine and in the femoral neck of 33 female and 35 male consenting psychiatric inpatients admitted consecutively. Patients were diagnosed as having major depressive disorder (N = 21), schizophrenia (N = 33), schizoaffective disorder (N = 7), mania (N = 2), and adjustment disorder (N = 5). Plasma levels of prolactin, estrogen, cortisol, and testosterone were also measured in a subgroup of these patients. It is reported that female patients, but especially male patients, had a highly significant decrease in bone mineral density when compared with age- and sex-matched normal data. It is suggested that psychiatric patients treated with antidepressants or neuroleptics might have decreased bone mineral density than is normal for their age and sex, and may be at an increased risk for fractures. These results may be related to low levels of gonadal hormones, especially in male subjects. Data should be confirmed with a larger number of patients with and without medications to distinguish between diagnosis-related and treatment-related effects.

This article has been cited by other articles:

				K. C. Horner, Y. Cazals, R. Guieu, M. Lenoir, and N. Sauze Experimental estrogen-induced hyperprolactinemia results in bone-related hearing loss in the guinea pig Am J Physiol Endocrinol Metab, November 1, 2007; 293(5): E1224 - E1232. [Abstract] [Full Text] [PDF]

				E. M. Haney, B. K. S. Chan, S. J. Diem, K. E. Ensrud, J. A. Cauley, E. Barrett-Connor, E. Orwoll, M. M. Bliziotes, and for the Osteoporotic Fractures in Men Study Group Association of Low Bone Mineral Density With Selective Serotonin Reuptake Inhibitor Use by Older Men Arch Intern Med, June 25, 2007; 167(12): 1246 - 1251. [Abstract] [Full Text] [PDF]

				L. HOWARD, G. KIRKWOOD, and M. LEESE Risk of hip fracture in patients with a history of schizophrenia The British Journal of Psychiatry, February 1, 2007; 190(2): 129 - 134. [Abstract] [Full Text] [PDF]

				N. Charoenphandhu, K. Tudpor, K. Thongchote, W. Saengamnart, S. Puntheeranurak, and N. Krishnamra High-calcium diet modulates effects of long-term prolactin exposure on the cortical bone calcium content in ovariectomized rats Am J Physiol Endocrinol Metab, February 1, 2007; 292(2): E443 - E452. [Abstract] [Full Text] [PDF]

				R. Yirmiya, I. Goshen, A. Bajayo, T. Kreisel, S. Feldman, J. Tam, V. Trembovler, V. Csernus, E. Shohami, and I. Bab From the Cover: Depression induces bone loss through stimulation of the sympathetic nervous system PNAS, November 7, 2006; 103(45): 16876 - 16881. [Abstract] [Full Text] [PDF]

				L. A. Milliken, J. Wilhelmy, C. J. Martin, N. Finkenthal, E. Cussler, L. Metcalfe, T. A. Guido, S. B. Going, and T. G. Lohman Depressive symptoms and changes in body weight exert independent and site-specific effects on bone in postmenopausal women exercising for 1 year. J. Gerontol. A Biol. Sci. Med. Sci., May 1, 2006; 61(5): 488 - 494. [Abstract] [Full Text] [PDF]

				J. Konstantynowicz, H. Kadziela-Olech, M. Kaczmarski, R. M. D. Zebaze, S. Iuliano-Burns, J. Piotrowska-Jastrzebska, and E. Seeman Depression in Anorexia Nervosa: A Risk Factor for Osteoporosis J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5382 - 5385. [Abstract] [Full Text] [PDF]

				M. Hummer, P. Malik, R. W. Gasser, A. Hofer, G. Kemmler, R. C. Moncayo Naveda, M. A. Rettenbacher, and W. W. Fleischhacker Osteoporosis in Patients With Schizophrenia Am J Psychiatry, January 1, 2005; 162(1): 162 - 167. [Abstract] [Full Text] [PDF]

				M. E. Mussolino, B. S. Jonas, and A. C. Looker Depression and Bone Mineral Density in Young Adults: Results From NHANES III Psychosom Med, July 1, 2004; 66(4): 533 - 537. [Abstract] [Full Text] [PDF]

				M. A. Whooley, J. A. Cauley, J. M. Zmuda, E. M. Haney, and N. W. Glynn Depressive Symptoms and Bone Mineral Density in Older Men J Geriatr Psychiatry Neurol, June 1, 2004; 17(2): 88 - 92. [Abstract] [PDF]

				A. M. Meaney, S. Smith, O. D. Howes, M. O'brien, R. M. Murray, and V. O'keane Effects of long-term prolactin-raising antipsychotic medication on bone mineral density in patients with schizophrenia The British Journal of Psychiatry, June 1, 2004; 184(6): 503 - 508. [Abstract] [Full Text] [PDF]

				C. L. Raison and A. H. Miller When Not Enough Is Too Much: The Role of Insufficient Glucocorticoid Signaling in the Pathophysiology of Stress-Related Disorders Am J Psychiatry, September 1, 2003; 160(9): 1554 - 1565. [Abstract] [Full Text] [PDF]

				A. WIECK and P. M. HADDAD Antipsychotic-induced hyperprolactinaemia in women: pathophysiology, severity and consequences: Selective literature review The British Journal of Psychiatry, March 1, 2003; 182(3): 199 - 204. [Abstract] [Full Text] [PDF]

				A. Wieck and P. Haddad Hyperprolactinaemia caused by antipsychotic drugs BMJ, February 2, 2002; 324(7332): 250 - 252. [Full Text] [PDF]

				G. Onder, C. Pedone, G. Gambassi, J. A. Baron, and K. Michaelsson Risk of Hip Fracture in Women: Not Only a Smoking Issue Arch Intern Med, January 14, 2002; 162(1): 101 - 102. [Full Text] [PDF]

				U. Halbreich and L. S. Kahn Are Women With Premenstrual Dysphoric Disorder Prone to Osteoporosis? Psychosom Med, May 1, 2001; 63(3): 361 - 364. [Abstract] [Full Text] [PDF]

				A. Herran, J. A. Amado, M. T. Garcia-Unzueta, J. L. Vazquez-Barquero, L. Perera, and J. Gonzalez-Macias Increased Bone Remodeling in First-Episode Major Depressive Disorder Psychosom Med, December 1, 2000; 62(6): 779 - 782. [Abstract] [Full Text] [PDF]

				U. Schweiger, B. Weber, M. Deuschle, and I. Heuser Lumbar Bone Mineral Density in Patients With Major Depression: Evidence of Increased Bone Loss at Follow-Up Am J Psychiatry, January 1, 2000; 157(1): 118 - 120. [Abstract] [Full Text]

				R. Bullock Older women with depression were at increased risk for falls and fractures Evid. Based Ment. Health, November 1, 1999; 2(4): 127 - 127. [Full Text]

				M. A. Whooley, K. E. Kip, J. A. Cauley, K. E. Ensrud, M. C. Nevitt, W. S. Browner, and for the Study of Osteoporotic Fractures Research G Depression, Falls, and Risk of Fracture in Older Women Arch Intern Med, March 8, 1999; 159(5): 484 - 490. [Abstract] [Full Text] [PDF]

				D. Michelson, C. Stratakis, L. Hill, J. Reynolds, E. Galliven, G. Chrousos, and P. Gold Bone Mineral Density in Women with Depression N. Engl. J. Med., October 17, 1996; 335(16): 1176 - 1181. [Abstract] [Full Text] [PDF]