Risperidone, but Not Olanzapine, Decreases Bone Mineral Density in Female Premenopausal Schizophrenia Patients
Abstract
BACKGROUND: The hyperprolactinemia induced by conventional antipsychotics often leads to osteoporosis. The commonly used atypical antipsychotics risperidone and olanzapine vary in their hyperprolactinemic properties. Therefore, we compared hormone profiles and bone properties in female premenopausal schizophrenia patients treated with either risperidone or olanzapine. METHOD: In a cross-sectional study, consecutive premenopausal, female, DSM-IV schizophrenia patients who were treated with either risperidone (N = 12) or olanzapine (N = 14) for at least 2 years were included. Dual energy X-ray absorptiometry evaluated bone mineral density, and multisite quantitative ultrasound measured bone speed of sound. In addition, profiles of urinary excretion of deoxypyridinoline and circulating levels of hormones and lipids were assessed. RESULTS: Serum prolactin levels were higher in the risperidone-treated group as compared with the olanzapine subjects (123 +/- 144 and 25.9 +/- 25.7, p <.05). Whereas bone mineral density was similar in the treatment groups, bone speed of sound was lower in the risperidone group as compared with the olanzapine-treated group. Expressed as age-adjusted Z score, bone speed of sound at the radius was -0.31 and 0.58, respectively, p <.05, and at the phalanx, -1.41 and 0.04, respectively, p <.05. The bone speed of sound in the risperidone-treated patients inversely correlated with urinary deoxypyridinoline excretion (r = 0.73, p <.05). CONCLUSION: Risperidone treatment, as opposed to olanzapine, for female premenopausal schizophrenia results in hyperprolactinemia and clinically relevant decrease in bone mineral density. The calculated relative risk for fragility fracture of women treated with risperidone as compared to those treated with olanzapine is 1.78 when bone speed of sound was measured at the phalanx and 1.23 when measured at the radius.
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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 [495]
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“Some studies (490493) 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.”
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BackgroundMethodResultInfluentialBone Mineral Density in Schizophrenia
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“However since then, a growing number of reports have focused on this topic (Abraham et al., 2003a; Becker et al., 2003; Howes et al., 2005; Lehman and Meyer, 2005), and a majority of them reported lower BMD in this population compared to healthy controls (Kishimoto et al., 2005; Renn et al., 2009;…”
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ResultSecond-generation antipsychotics and bone turnover in schizophrenia
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“Nevertheless, the adjusted bone speed of sound was significantly lower in the hyperprolactinemia group at the radius and phalanx [33].”
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“Some have further investigated duration of use, finding chronic use to be related with reduced bone mineralization (3, 7, 8, 31).”
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“Such effect is presumably associated with the hyperprolactinemic effect of these atypical antipsychotics, which is high in risperidone and low in olanzapine [23].”
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“In addition, Risperidone is known to contribute to BMD reduction in female patients with premenopausal schizophrenia (Becker et al. 2003).”
BackgroundFactors associated with decreased bone mineral density in postmenopausal women with schizophrenia
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Gynecologic and Reproductive Health Concerns of Adolescents Using Selected Psychotropic Medications
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“However, because we did not observe a significant risk of osteoporosis in the non-SUD psychotic disorders group, this may suggest that comorbid substance use plays a significant role and may partially explain the higher rates of bone loss seen in other studies where substance use was not reported [12, 16, 33].”
ResultLiang, Y., Su, Y.-A., Zhao, Z.-G., Gao, N., Huang, J.-Z., Tang, M.-Q., Li, K.-Q., Yang, F.-D., Yu, X., & Si, T.-M. (2015) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000379 · Cited by 6 · see citing works
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“Early studies of patients treated with risperidone found high PRL levels to be associated with low BMD values (Becker et al., 2003).”
BackgroundSpezielle Aspekte der pharmakotherapeutischen Behandlung forensisch untergebrachter Patientinnen
Singer, M., & Eckermann, G. (2023) · Forensische Psychiatrie Psychologie Kriminologie · doi:10.1007/s11757-023-00762-y · Cited by 5 · see citing works
“…(Oligomenorrhö, Amenorrhö) sowie Brustspannungsschmerzen und Milchfluss betroffen sein können, und langfristig wie auch bei Männern das Risiko für Osteoporose aufgrund reduzierter Knochenmineraldichte steigt (O’Keane und Meaney 2005; Becker et al. 2003; Aichhorn et al. 2007; Hummer et al. 2005).”
BackgroundAntipsychotika und Hyperprolaktinämie: Pathophysiologie, klinische Bedeutung, Abklärung und Therapie
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- Authors
- Becker, D., Liver, O., Mester, R., Rapoport, M., Weizman, A., & Weiss, M.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2003-07-15
- Volume
- 64
- Issue
- 7
- Pages
- 761-766
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2071226732
- Cited by
- 107
- References
- 0
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 7 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 4 · 2015: 4 · 2014: 1 · 2013: 4 · 2012: 6
- FWCI
- 4.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Keywords
- risperidone, olanzapine, schizophrenia, bone mineral density, hyperprolactinemia, atypical antipsychotics, osteoporosis, bone speed of sound, deoxypyridinoline, fragility fracture risk, prolactin
- MeSH terms
- Olanzapine, Adolescent, Adult, Benzodiazepines, Female, Humans, Middle Aged, Osteoporosis, Pirenzepine, Prolactin, Schizophrenia, Serotonin Antagonists, Absorptiometry, Photon, Bone Density, Selective Serotonin Reuptake Inhibitors, Premenopause, Risperidone
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