Wednesday, November 16, 2022

Long-Term Use of Some Antipsychotics Increases Risk of Fractures, Study Shows

Individuals who take antipsychotics that increase the hormone prolactin for four years or more are at heightened risk of low-energy fractures (fractures resulting from falls from standing height or lower), according to a report in Schizophrenia Bulletin.

Most first-generation antipsychotics increase prolactin levels, as do the second-generation antipsychotics risperidone and paliperidone. Prolactin-sparing antipsychotics (known to slightly increase levels of prolactin) include aripiprazole, clozapine, and quetiapine, among others.

High levels of prolactin (hyperprolactinemia) can cause a decrease in bone mass density, wrote Marco Solmi, M.D., of the University of Ottawa, and colleagues. “In subjects treated with prolactin-increasing antipsychotics, prolactin levels should be monitored and hyperprolactinemia should be avoided when possible and treated when it occurs,” they wrote.

The researchers used Finnish national birth registries to look at the use of prolactin-increasing and prolactin-sparing antipsychotics among 4,960 people with schizophrenia who experienced a low-energy fracture and 24,451 people with schizophrenia who did not experience a low-energy fracture, matched for age, sex, and duration of illness. About 61.5% of all subjects were females, with a mean age of 62 years.

Those with schizophrenia who took prolactin-increasing antipsychotics for 4 to 7 years were 22% more likely to experience a low-energy fracture than those who took medications for less than one year. The longer participants took the prolactin-increasing antipsychotics, the greater the risk of a low-energy fracture: People who took the medications for 7 to 10 years had a 30% increase in low-energy fracture; exposure greater than 13 years carried a 38% increased risk low-energy fracture. All dosages of prolactin-increasing antipsychotics carried an increased risk of low-energy fracture, with the risk rising as the dosage increased.

For prolactin-sparing antipsychotics, only very high doses (greater than 6,000 defined daily doses) were associated with increased risk of low-energy fracture.

“Prevention of hyperprolactinemia can be successfully achieved by prescribing prolactin-sparing antipsychotics,” Solmi and colleagues wrote. Such medications include partial D2 agonists aripiprazole, brexpiprazole, cariprazine, and lumateperone; clozapine; and quetiapine.

For related information, see the Psychiatric News article “Patients Taking Psychotropic Medications Found to Be at Elevated Risk of Fractures.”

(Image: iStock/stevecoleimages)


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