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You refer to the side effects of antipsychotics which can increase the risk of falls and fractures as being orthostatic hypertension, sedation and extra pyramidal symptoms. We wanted to add that hyperprolactinaemia associated with antipsychotics also increases the risk of bone mineral density loss, and subsequent risk of fractures.
Veronica O’Keane (1), among others, has demonstrated that antipsychotic-induced prolactinaemia causes similar suppression of the reproductive endocrine axis to non-antipsychotic induced prolactinaemia, with consequent bone mineral density loss. Risperidone, which is the treatment of choice, and the only licensed drug in the UK for management of non-cognitive symptoms in patients with neurocognitive disorders, is in the highest risk category for effect on prolactin, with major increases in prolactin seen (2). It is therefore important this is considered when discussing the association between antipsychotics and fractures.
References
1. O’Keane V. Antipsychotic induced hyperprolactinaemia, hypogonadism and osteoporosis in the treatment of schizophrenia. Journal of Psychopharmacology 2008; 22(2): 70-75
2. Taylor DM et al., 2018. The Maudsley Prescribing Guidelines in Psychiatry. 13th ed. Chichester:Wiley.
Hyperprolactinaemia as an additional risk factor for fractures
Dear Editor
You refer to the side effects of antipsychotics which can increase the risk of falls and fractures as being orthostatic hypertension, sedation and extra pyramidal symptoms. We wanted to add that hyperprolactinaemia associated with antipsychotics also increases the risk of bone mineral density loss, and subsequent risk of fractures.
Veronica O’Keane (1), among others, has demonstrated that antipsychotic-induced prolactinaemia causes similar suppression of the reproductive endocrine axis to non-antipsychotic induced prolactinaemia, with consequent bone mineral density loss. Risperidone, which is the treatment of choice, and the only licensed drug in the UK for management of non-cognitive symptoms in patients with neurocognitive disorders, is in the highest risk category for effect on prolactin, with major increases in prolactin seen (2). It is therefore important this is considered when discussing the association between antipsychotics and fractures.
References
1. O’Keane V. Antipsychotic induced hyperprolactinaemia, hypogonadism and osteoporosis in the treatment of schizophrenia. Journal of Psychopharmacology 2008; 22(2): 70-75
2. Taylor DM et al., 2018. The Maudsley Prescribing Guidelines in Psychiatry. 13th ed. Chichester:Wiley.
Competing interests: No competing interests