Mercurio Michele, Spina Giovanna, Galasso Olimpio, Gasparini Giorgio, Segura-Garcia Cristina, De Fazio Pasquale, de Filippis Renato
Department of Orthopaedic and Trauma Surgery, Magna Graecia University, "Renato Dulbecco" University Hospital, V.le Europa, (Loc. Germaneto), 88100 Catanzaro, Italy.
Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG, Magna Graecia University, 88100 Catanzaro, Italy.
Diagnostics (Basel). 2024 Dec 5;14(23):2745. doi: 10.3390/diagnostics14232745.
Antipsychotic drugs appear to be related to reduced bone mineral density (BMD). We conducted a narrative review to collect the available literature investigating the relationship between antipsychotic use and bone fragility.
A review of the published literature was conducted and reported through PubMed/Scopus/Cochrane libraries. We included studies using any antipsychotic treatment where the bone metabolism, osteoporosis, and/or risk of fractures has been assessed.
After screening 1707 items, we finally included 15 papers. A total of 3245 initial patients were identified, of whom 1357 patients with a mean age of 43.8 years underwent antipsychotic treatment and were analyzed. The mean antipsychotic treatment duration of the treated group was 15.8 ± 13.9 years. Among the included studies, two reported a statistically significant difference in lumbar BMD reduction between the antipsychotic exposed group and the control group. Femoral neck BMD levels had been reported in four of the case-control studies; two reported a statistically significant difference in femoral neck BMD reduction between the antipsychotic exposed group and the control group.
Prolonged use of antipsychotic treatment seems to be associated with an increased risk of reduced BMD, and, consequentially, with an augmented risk of bone fragility and fractures. This effect is not limited to vulnerable groups, such as those with significant medical comorbidities, the elderly, and postmenopausal women, but may also apply to anyone using antipsychotics in the long-term. Clinicians' awareness of antipsychotic prescriptions should optimize their potential while reducing this risk.
抗精神病药物似乎与骨矿物质密度（BMD）降低有关。我们进行了一项叙述性综述，以收集有关抗精神病药物使用与骨脆性之间关系的现有文献。
通过PubMed/Scopus/Cochrane图书馆对已发表的文献进行综述并报告。我们纳入了使用任何抗精神病药物治疗且评估了骨代谢、骨质疏松症和/或骨折风险的研究。
在筛选了1707篇文章后，我们最终纳入了15篇论文。共确定了3245名初始患者，其中1357名平均年龄为43.8岁的患者接受了抗精神病药物治疗并进行了分析。治疗组的平均抗精神病药物治疗时长为15.8±13.9年。在纳入的研究中，两项研究报告了抗精神病药物暴露组和对照组之间腰椎BMD降低存在统计学显著差异。四项病例对照研究报告了股骨颈BMD水平；两项研究报告了抗精神病药物暴露组和对照组之间股骨颈BMD降低存在统计学显著差异。
长期使用抗精神病药物治疗似乎与BMD降低风险增加相关，进而与骨脆性和骨折风险增加相关。这种影响不仅限于弱势群体，如患有严重合并症的患者、老年人和绝经后女性，长期使用抗精神病药物的任何人都可能受到影响。临床医生对抗精神病药物处方的认识应在降低这种风险的同时优化其潜在益处。
