Psychotropic drugs and bone

Abstract

The purpose of this article is to provide an overview of the effects of psychotropic medications on bone metabolism, bone mineral density (BMD), and fracture risk. Methods. The literature search was carried out in PubMed. The keywords used were “osteoporosis”, “bone”, “fracture”, “psychotropic medication”, “antidepressants”, “antipsychotics”, “neuroleptics”, “hyperprolactinemia”, and “lithium”. Results. Psychotropic drugs from the group of antidepressants or neuroleptics (antipsychotics) and lithium preparations have different effects on the bone. On the one hand, they can trigger the development of osteoporosis with an increased risk of fractures (antidepressants, neuroleptics); on the other hand, some of the compounds also show a bone-protective effect (lithium preparations). Antidepressants, in general, lead to an increase in serotonin and/or noradrenaline in the synapses. On bone, they cause a decrease in BMD and, consequently, an increase in the risk of fractures. Neuroleptics act as dopamine receptor antagonists and lead to hyperprolactinemia and, thus, to secondary hypogonadism. This has a direct negative effect on osteoblasts, leading to decreased BMD and an increased risk of fractures. Lithium salts, on the other hand, are bone-protective. Therapy with lithium preparations is associated with a decrease in fracture risk. In case of therapy with psychotropic drugs, particularly antidepressants or neuroleptics, attention should also be paid to bone health, especially in patients at risk (age, tendency to fall, comedication, preexisting osteoporosis, fractures). Conclusions. The increased tendency to fractures during psychotropic drug therapy is usually multifactorial since, in addition to the direct adverse effects of the medication on the bone, there can also be an increased tendency to fall and a decreased BMD due to mental illness per se. Psychotropic drug therapy should be optimized, taking into account the potential side effects, including the increased risk of fractures.

Keywords

• antidepressants
• neuroleptics (antipsychotics)
• lithium preparations
• osteoporosis
• fracture risk