Bone mineral density changes over a year in young females with schizophrenia: Relationship to medication and endocrine variables
Bone mineral density changes over a year in young females with schizophrenia: Relationship to medication and endocrine variables
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DOI：
10.1016/j.schres.2007.01.013
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发表时间：
2007-07-01
影响因子：
4.5
通讯作者：
O'Keane, V.
中科院分区：
文献类型：
--
作者：
Meaney, A. M.;O'Keane, V.
前言：高催乳素血症与精神分裂症患者使用有效的多巴胺-2受体阻滞剂有关，也与普通人群中的骨质丢失有关。与接受催乳素刺激的抗精神病药物相比，接受催乳素升高的抗精神病药物治疗的年轻绝经前女性精神分裂症患者的骨密度(BMD)降低的比率明显更高。这项前瞻性研究比较了服用催乳素增高剂(如利培酮、阿米苏必利或DART抗精神病药物)和保留催乳素(奥氮平)抗精神病药物的患者在一年时间内的骨密度变化。在患者接受促催乳素、抗精神病药物或奥氮平治疗的情况下，也检验了改善骨密度的特定干预措施的效果。方法：绝经前女性患者(n=38)，在治疗期间单独接受促催乳素(n=25)或非催乳素(n=13)抗精神病药物治疗，在基线水平和每3个月进行一次临床、内分泌和骨标记物评估，为期1年。在基线和1年随访时用双能X线骨密度仪测量骨密度。结果：在没有接受任何改善骨密度的特定干预措施的组中，不使用催乳素的患者腰椎骨密度值总体增加，而不使用催乳素的患者腰椎骨密度值总体下降(p=0.02)。在接受特定干预的小组中，接受不含催乳素的抗精神病药物的亚组随着时间的推移腰椎(p=0.01)和髋部(p=0.01)骨密度显著增加，而促催乳素亚组的变化不显著。讨论：服用促催乳素的抗精神病药物且未接受特定干预以提高骨密度的妇女有证据表明，一年多来，持续的骨脱钙；而服用不含催乳素的抗精神病药物的妇女的骨密度总体上有温和的增加。大多数临床干预措施似乎都有帮助，但对那些服用催乳素节约型抗精神病药物的人来说，效果明显更好。(C)2007年，爱思唯尔出版。
Introduction: Hyperprolactinaemia is associated with the use of potent dopamine-2 receptor blocking anti-psychotic agents in schizophrenia and with bone loss in the general population. Significantly higher rates of reduced bone mineral density (BMD) have been identified in young pre-menopausal females with schizophrenia receiving prolactin-raising anti-psychotics compared to those receiving prolactin-spaing anti-psychotics. This prospective study compared BMD alterations over a period of 1 year in patients maintained on either prolactin-raising (e.g. risperidone, amisulpride or depot anti-psychotics) or prolactin-sparing (olanzapine) antipsychotics. The effects of specific interventions to improve BMD were also examined in the context of whether patients were receiving either prolactin-raising or anti-psychotics or Olanzapine.Methods: Pre-menopausal females (n = 3 8) with a diagnosis of schizophrenia, who had received exclusively either prolactin-raising (n = 25) or prolactin-sparing (n = 13) anti-psychotics during their treatment history, had clinical, endocrine and bone marker assessments performed at baseline and every 3 months for a period of 1 year. BMD was measured by DEXA scan at baseline and at 1-year follow-up. Patients from both groups either received specific interventions (n = 16) or no interventions (n = 16) to improve bone density.Results: There was an overall gain in lumbar BMD values in the prolactin-sparing subgroup, compared to an overall loss in the prolactin-raising subgroup (p = 0.02), for the groups that received no specific interventions to improve BMD. Within the group that received specific interventions, the subgroup receiving prolactin-sparing anti-psychotics had a significant increase in lumbar (p = 0.01) and hip (p = 0.01) BMD over time, whereas alterations in the prolactin-raising subgroup were not significant.Discussion: Women taking prolactin-raising anti-psychotics and not receiving specific interventions to improve bone density had evidence of ongoing bone demineralisation over a year; whereas women taking prolactin-sparing anti-psychotics had a modest overall increase in BMD. Most clinical interventions appeared to be helpful, but were significantly more effective in those taking prolactin-sparing anti-psychotics. (c) 2007 Published by Elsevier B.V.