Risperidone, but Not Olanzapine, Decreases Bone Mineral Density in Female Premenopausal Schizophrenia Patients
J Clin Psychiatry 2003;64(7):761-766
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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.