Bone Health Implications of Psychotropic and Antipsychotic Medications

Psychotropic and antipsychotic agents, encompassing antidepressants, mood stabilisers and antipsychotic drugs, exert unintended effects on skeletal integrity across diverse patient populations. Antipsychotics that elevate prolactin disrupt gonadal hormones, leading to diminished bone mineral density (BMD) and heightened fracture risk. Selective serotonin reuptake inhibitors modulate osteoblast and osteoclast activity via serotonin receptors in bone, impairing bone formation and accelerating resorption. Depression itself or chronic stress may further dysregulate bone remodelling through inflammatory and neuroendocrine pathways. Clinical observations reveal that individuals with severe mental illness, particularly schizophrenia, exhibit reduced BMD at central sites and increased incidence of fragility fractures. Advances in understanding of bone turnover markers, such as C-terminal telopeptide of type I collagen and procollagen type I N-terminal propeptide, have enabled early detection of drug-induced alterations in bone remodelling. Cross-disciplinary research emphasises the importance of regular skeletal screening, lifestyle intervention and optimised pharmacotherapy to mitigate long-term skeletal complications. The global burden of mental disorders and the widespread use of psychotropic medications underscore the need for integrated strategies to preserve bone health without compromising psychiatric management.

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Bone Health Implications of Psychotropic and Antipsychotic Medications publication trend

The graph below shows the total number of articles in bone health implications of psychotropic and antipsychotic medications across all publications each year (not limited to Nature Index journals).

Technical terms

Bone mineral density (BMD): A quantitative measure of the mineral content in bone, used to assess fracture risk.

Osteoporosis: A skeletal disorder characterised by low bone mass and microarchitectural deterioration, increasing fracture susceptibility.

Bone turnover markers: Biomolecules released during bone formation or resorption, indicative of changes in bone remodelling activity.

Hyperprolactinaemia: Elevated serum prolactin levels, often induced by certain antipsychotics, leading to hypogonadism and bone loss.

Prolactin-raising antipsychotics: Antipsychotic agents that increase prolactin secretion, associated with adverse effects on bone metabolism.

References

1. The neglected association between schizophrenia and bone fragility: a systematic review and meta-analyses. Translational Psychiatry (2024).
2. Effects of fish oil supplementation on bone turnover markers in depression: a pilot study. Frontiers in Nutrition (2024).
3. Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions. Frontiers in Psychiatry (2019).
4. Expression of Serotonin Receptors in Bone*. Journal of Biological Chemistry (2001).