Effects of Psychiatric Disorders and Psychotropic Medications on Prolactin and Bone Metabolism
Abstract
OBJECTIVE: Osteoporosis occurs in common psychiatric conditions and causes significant morbidity. Many neuroleptic medications can cause hyperprolactinemia, which can then potentially be associated with bone loss. Few reviews have thus far addressed this issue. We have consolidated information from studies that examined effects of psychiatric conditions and their treatment on bone metabolism. DATA SOURCES: We searched PubMed for original articles and reviews published between 1976 and 2004 that described changes in bone metabolism in psychiatric disorders and examined prolactin elevations with neuroleptic medications. Keywords used were major depressive disorder, bipolar disorder, schizophrenia, bone density, bone metabolism, hyperprolactinemia, typical antipsychotics, and atypical antipsychotics. STUDY SELECTION AND DATA EXTRACTION: 160 articles published in peer-reviewed journals were identified and are summarized, with greater emphasis given to data from larger, controlled studies. DATA SYNTHESIS: Schizophrenia and major mood disorders are often associated with perturbations in bone metabolism related to factors including nutritional alterations, smoking, and hypogonadotropic hypogonadism, with or without medication-induced hyperprolactinemia. Polydipsia can contribute to bone loss in schizophrenia, whereas hypercortisolemia is often associated with low bone density in depression. Lithium in bipolar disorder and thyroid-stimulating hormone-suppressive doses of L-thyroxine have a negative impact on bone health. Mood stabilizers such as carbamazepine and valproate can also affect bone density. Hyperprolactinemia may lead to bone loss only if associated with untreated amenorrhea in women or testosterone deficiency in men. Some atypical neuroleptics, by causing lesser elevations in prolactin, may therefore have a less marked impact on bone than typical neuroleptics. CONCLUSIONS: Because significant morbidity is associated with low bone density and many psychiatric conditions may have a negative impact on bone metabolism, bone density evaluation should be considered an integral component of chronic medical care of these disorders, and risk factors should be identified and addressed.
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In comparison with the general population, untreated patients with schizophrenia appear to have an increased risk of developing osteoporosis.
“In comparison with the general population, untreated patients with schizophrenia appear to have an increased risk of developing 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 [470]
The increased risk of osteoporosis in untreated schizophrenia is due to the disease itself and to risk factors related to lifestyle (e.g., smoking, reduced physical activity, alcohol abuse, vitamin D and calcium deficiency, polydipsia).
“On the one hand, this is because of the disease itself, on the other hand, because of risk factors related to their lifestyle (e.g., smoking, reduced physical activity, alcohol abuse, vitamin D and calcium deficiency, polydipsia) (470-476).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [470]
Schizophrenia, schizoaffective states, major depression and bipolar disorder are known to be associated with low bone mineral density.
“Schizophrenia, schizoaffective states, major depression and bipolar disorder are known to be associated with low bone mineral density (BMD) (470).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [470]
Although lithium has a potentially negative impact on bone metabolism, it is associated with lower fracture risk (OR=0.6) and seems to be protective against fractures.
“Although lithium has a potentially negative impact on bone metabolism (470), it is associated with lower fracture risk (OR=0.6)and, thus, seems to be protective against fractures (504,505).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [470]
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“The medical management of patients with BD is complex (12), with drug regimens that usually contain antidepressants, antipsychotics, and mood stabilizers, all of which may affect BMD (13, 14).”
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- Authors
- Misra, M., Papakostas, G. I., & Klibanski, A.
- Affiliations
- Massachusetts General Hospital (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2004-12-15
- Volume
- 65
- Issue
- 12
- Pages
- 1607-1618
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2038772075
- Cited by
- 156
- References
- 0
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 3 · 2016: 18 · 2015: 5 · 2014: 9 · 2013: 8 · 2012: 7
- FWCI
- 7.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK062249, DK 062249)
- National Center for Research Resources (K23RR018851)
- 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
- hyperprolactinemia, bone metabolism, osteoporosis, bone mineral density, mental illness, antipsychotic drugs, schizophrenia, major depressive disorder, bipolar disorder, lithium, hypogonadotropic hypogonadism, hypercortisolism, polydipsia, atypical antipsychotics, mood stabilizers, valproic acid, carbamazepine, levothyroxine, amenorrhea, androgen deficiency
- MeSH terms
- Adult, Anticonvulsants, Mental Disorders, Bipolar Disorder, Bone and Bones, Major Depressive Disorder, Depressive Disorder, Female, Humans, Hyperprolactinemia, Hypogonadism, Lithium, Male, Osteoporosis, Prolactin, Psychotic Disorders, Psychotropic Drugs, Schizophrenia, Bone Density, Comorbidity
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