Raffin Marie, Bonnot Olivier, Giannitelli Marianna, Xavier Jean, Bodeau Nicolas, Bibrac Barbara, Leban Monique, Fautrel Bruno, Menard Marie-Line, Consoli Angele, Cohen David
Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France.
Groupe de Recherche Clinique n°15 (PSYDEV), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, UPMC Univ Paris 06, Paris, France.
J Child Adolesc Psychopharmacol. 2018 Dec;28(10):719-726. doi: 10.1089/cap.2017.0158. Epub 2018 Nov 13.
Osteoporosis is a major risk factor for fracture and treatment is mainly preventive. Patients with severe psychiatric condition and treated with antipsychotics are at risk for vitamin D deficiency and iatrogenic hyperprolactinemia, two serious risk factors of osteoporosis. We aim to determine whether all antipsychotics are similar regarding the risk of osteoporosis in young patients. From January 2009 to March 2015, we determined the vitamin D blood level (VDBL) among 484 inpatients and from January 2012 to March 2015, we determined the prolactin blood level (PBL) among 205 inpatients. We systematically recorded well-documented risk factors (e.g., age, gender, ethnic origin, body mass index, or season) and suspected risk factors (e.g., disease type or antipsychotic treatment). Up to 89% of the inpatients had a VDBL under the recommended threshold. Up to 60% of the inpatients had hyperprolactinemia. The multivariate model found a significant effect on VDBL for seasonality (higher VDBL in summer), ethnicity (lower VDBL in Black individuals), and treatment exposure. The multivariate model found a significant effect on PBL for gender and treatment exposure. In both models, aripiprazole had a safer profile compared with other antipsychotics. Because adolescence is a period of bone construction and a critical window of opportunity for maximizing bone mass, we recommend vitamin D supplementation in young patients with severe mental condition. It could be interesting to reconsider to regularly monitor PBL among youth patients treated with antipsychotic, with the exception of aripiprazole.
骨质疏松症是骨折的主要风险因素，治疗主要以预防为主。患有严重精神疾病并接受抗精神病药物治疗的患者有维生素D缺乏和医源性高催乳素血症的风险，这是骨质疏松症的两个严重风险因素。我们旨在确定所有抗精神病药物在年轻患者中导致骨质疏松症的风险是否相似。从2009年1月至2015年3月，我们测定了484名住院患者的维生素D血水平（VDBL），从2012年1月至2015年3月，我们测定了205名住院患者的催乳素血水平（PBL）。我们系统地记录了记录完善的风险因素（如年龄、性别、种族、体重指数或季节）和疑似风险因素（如疾病类型或抗精神病药物治疗）。高达89%的住院患者VDBL低于推荐阈值。高达60%的住院患者有高催乳素血症。多变量模型发现季节性（夏季VDBL较高）、种族（黑人个体VDBL较低）和治疗暴露对VDBL有显著影响。多变量模型发现性别和治疗暴露对PBL有显著影响。在两个模型中，与其他抗精神病药物相比，阿立哌唑的情况更安全。由于青春期是骨骼构建期，也是使骨量最大化的关键机会窗口，我们建议对患有严重精神疾病的年轻患者补充维生素D。重新考虑对接受抗精神病药物治疗的青年患者（阿立哌唑除外）定期监测PBL可能会很有意义。
