High bone turnover but normal bone mineral density in women suffering from schizophrenia
Abstract
Background: A potential association between schizophrenia and osteoporosis or osteopenia has recently been reported. Various factors affect bone mineral density (BMD) such as polydipsia, nicotine, alcohol abuse, lack of physical activity, an unbalanced diet, a lack of ultraviolet exposure and/or vitamin D. In addition, decreased BMD in women with schizophrenia has been attributed to drug-induced hyperprolactinaemia and/or secondary hypogonadism. This study was undertaken because empirical evidence from larger patient cohorts is limited and the data are still controversial. Method: Seventy-two premenopausal, regularly menstruating women suffering from schizophrenia and 71 age- and sex-matched healthy controls were included in the study. Biochemical markers of bone turnover (serum osteocalcin, urinary pyridinium crosslinks), parathyroid hormone and 25-hydroxyvitamin D were measured. BMD at the femoral neck and lumbar spine was determined by dual-energy X-ray absorptiometry in a subgroup of 59 patients. In addition, 17β-oestradiol, prolactin, testosterone, gonadotrophins and dehydroepiandrosterone sulfate were measured. Results: Compared with healthy controls, both markers of formation and resorption were increased in women with schizophrenia. However, in the subgroup of 59 patients, BMD was within the normal range. In women suffering from schizophrenia, testosterone levels were higher than in controls, and serum oestradiol levels were lower compared with the normal range. Conclusion: Despite significantly increased bone turnover, we conclude that premenopausal and regularly menstruating women suffering from schizophrenia have normal spine and hip BMD. This may be due to the opposite effects of the various parameters influencing bone metabolism, especially of the gonadal hormones, and due to an intact coupling mechanism.
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Some studies found a relationship between the use of prolactin-raising medication and low bone mineral density in patients with chronic schizophrenia, while others failed to find a relationship between prolactin, antipsychotics and osteoporosis.
“Some studies (490-493) found a relationship between the use of prolactin-raising medication and low BMD in patients with chronic schizophrenia, while others (474,489,494-498) failed to find a relationship between prolactin, AP and osteoporosis.”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [489]
Clinical data implicating antipsychotic-induced hyperprolactinemia as a possible major risk factor for bone loss are limited and contradictory.
“Although it has been suggested that raised prolactin levels provoked by AP medication can lead to an increased risk of osteoporosis in patients with schizophrenia (471, 487), clinical data implicating AP-induced hyperprolactinemia as a possible major risk factor for bone loss are limited and contradictory (488,489).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [489]
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- Authors
- Bergemann, N., Parzer, P., Mundt, C., & Auler, B.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Bergemann, N.
- ORCID
- Parzer, P.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2008-03-26
- Volume
- 38
- Issue
- 8
- Pages
- 1195-1201
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2118672953
- Cited by
- 37
- References
- 48
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 4 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- schizophrenia, bone mineral density, bone turnover, osteoporosis, osteopenia, women, premenopausal women, osteocalcin, parathyroid hormone, 25-hydroxyvitamin D, testosterone, estradiol, hypogonadism, hyperprolactinemia, bone metabolism
- MeSH terms
- Adult, Estradiol, Female, Humans, Light, Male, Middle Aged, Osteoporosis, Parathyroid Hormone, Schizophrenia, Testosterone, Vitamin D, Absorptiometry, Photon, Bone Density, Osteocalcin, Diagnostic and Statistical Manual of Mental Disorders
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