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Radojkovic DB, Pesic M, Radojkovic M, Vukelic Nikolic M, Jevtovic Stoimenov T, Radenkovic S, Ciric V, Basic D, Radjenovic Petkovic T. Significance of Duodenal Prolactin Receptor Modulation by Calcium and Vitamin D in Sulpiride-Induced Hyperprolactinemia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:942. [PMID: 38929559 PMCID: PMC11205369 DOI: 10.3390/medicina60060942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Hyperprolactinemia, as a potential side-effect of some antipsychotic medications, is associated with decreased bone density and an increased risk of fractures. This study investigates whether calcium and vitamin D supplementation affects prolactin receptor (Prlr) gene expression in the duodenum, vertebrae, and kidneys of female rats with sulpiride-induced hyperprolactinemia. Materials and Methods: Twenty-one-week-old female Wistar rats were assigned to three groups: Group S consisted of ten rats who received sulpiride injections (10 mg/kg) twice daily for 6 weeks; Group D (10 rats) received daily supplementation of 50 mg calcium and 500 IU vitamin D along with sulpiride for the last 3 weeks; and Group C consisting of seven age-matched nulliparous rats serving as a control group. Real-time PCR was used to assess Prlr gene expression in the duodenum, vertebrae, and kidneys. Results: In Group S, Prlr gene expression was notably decreased in the duodenum (p < 0.01) but elevated in the vertebrae and kidneys compared to Group C. Conversely, Group D exhibited significantly increased Prlr expression in the duodenum (p < 0.01) alongside elevated expression in the vertebrae and kidneys. Conclusions: In sulpiride-induced hyperprolactinemia, decreased Prlr gene expression in the duodenum may lead to reduced intestinal calcium absorption. Consequently, prolactin may draw calcium from the skeletal system to maintain calcium balance, facilitated by increased Prlr gene expression in the vertebrae. However, vitamin D supplementation in sulpiride-induced hyperprolactinemia notably enhances Prlr gene expression in the duodenum, potentially ameliorating intestinal calcium absorption and mitigating adverse effects on bone health.
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Affiliation(s)
- Danijela Branislav Radojkovic
- Medical Faculty, University of Nis, Blvd. Dr Zoran Djindjic 81, 18000 Nis, Serbia; (M.P.); (M.R.); (M.V.N.); (T.J.S.); (S.R.); (V.C.)
- Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center Nis, Blvd. Dr Zoran Djindjic 48, 18000 Nis, Serbia
| | - Milica Pesic
- Medical Faculty, University of Nis, Blvd. Dr Zoran Djindjic 81, 18000 Nis, Serbia; (M.P.); (M.R.); (M.V.N.); (T.J.S.); (S.R.); (V.C.)
- Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center Nis, Blvd. Dr Zoran Djindjic 48, 18000 Nis, Serbia
| | - Milan Radojkovic
- Medical Faculty, University of Nis, Blvd. Dr Zoran Djindjic 81, 18000 Nis, Serbia; (M.P.); (M.R.); (M.V.N.); (T.J.S.); (S.R.); (V.C.)
- Surgery Clinic, University Clinical Center Nis, Blvd. Dr Zoran Djindjic 48, 18000 Nis, Serbia
| | - Marija Vukelic Nikolic
- Medical Faculty, University of Nis, Blvd. Dr Zoran Djindjic 81, 18000 Nis, Serbia; (M.P.); (M.R.); (M.V.N.); (T.J.S.); (S.R.); (V.C.)
| | - Tatjana Jevtovic Stoimenov
- Medical Faculty, University of Nis, Blvd. Dr Zoran Djindjic 81, 18000 Nis, Serbia; (M.P.); (M.R.); (M.V.N.); (T.J.S.); (S.R.); (V.C.)
| | - Sasa Radenkovic
- Medical Faculty, University of Nis, Blvd. Dr Zoran Djindjic 81, 18000 Nis, Serbia; (M.P.); (M.R.); (M.V.N.); (T.J.S.); (S.R.); (V.C.)
- Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center Nis, Blvd. Dr Zoran Djindjic 48, 18000 Nis, Serbia
| | - Vojislav Ciric
- Medical Faculty, University of Nis, Blvd. Dr Zoran Djindjic 81, 18000 Nis, Serbia; (M.P.); (M.R.); (M.V.N.); (T.J.S.); (S.R.); (V.C.)
- Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center Nis, Blvd. Dr Zoran Djindjic 48, 18000 Nis, Serbia
| | - Dijana Basic
- Psychiatry Clinic, University Clinical Center Nis, Blvd. Dr Zoran Djindjic 48, 18000 Nis, Serbia;
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Nirmal D, Abdul S, Jaiswal P, Naunihal Singh S, Avaragollapuravarga Mathada A, Nagaraj P. Effect of duration of sodium valproate therapy on bone mineral density and vitamin D levels. Epilepsy Behav 2024; 153:109733. [PMID: 38447300 DOI: 10.1016/j.yebeh.2024.109733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study aimed to evaluate the impact of prolonged sodium valproate use on bone mineral density (BMD) and Vitamin D levels in pediatric epilepsy patients. METHODS In a cross-sectional study conducted at the Epilepsy Clinic of Niloufer Hospital, Hyderabad, India, 50 pediatric patients (aged 4-10 years) were recruited. The cohort comprised 30 epilepsy patients on sodium valproate treatment (cases) and 20 healthy siblings without epilepsy or valproate use (controls). BMD was assessed using dual-energy X-ray absorptiometry to measure height-adjusted total body less head Z-scores (TBLH Z-scores), and serum 25-hydroxyvitamin D levels were measured. Statistical analysis included independent samples t-tests, Mann-Whitney U tests, and Pearson correlation, with a preliminary power analysis ensuring adequate sample size. RESULTS Cases exhibited significantly lower BMD TBLH Z-scores (Mean = -1.543) compared to controls (Mean = 0.515, p <.001) and reduced Vitamin D levels (Mean = 9.17 for cases vs. 27.80 for controls, p <.001). A negative correlation was observed between the duration of sodium valproate use and both BMD Z-scores (r = -0.626, p <.001) and Vitamin D levels (r = -0.707, p <.001). CONCLUSIONS The findings suggest a significant negative impact of prolonged sodium valproate use on both bone density and Vitamin D levels in pediatric patients. These results underscore the importance of monitoring and managing bone health in children receiving long-term sodium valproate therapy.
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Affiliation(s)
- Dinesh Nirmal
- Niloufer Hospital for Women and Children, Hyderabad, India.
| | - Samee Abdul
- Niloufer Hospital for Women and Children, Hyderabad, India
| | | | | | | | - Preeti Nagaraj
- Niloufer Hospital for Women and Children, Hyderabad, India
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Li S, Chen X, Qiu Y, Teng Z, Xu X, Tang H, Xiang H, Wang B, Chen J, Yuan H, Wu H. Osteoporosis and low bone mass among schizophrenia and bipolar disorder: A cross-sectional study with newly diagnosed, drug-naïve subjects. J Affect Disord 2024; 348:297-304. [PMID: 38159657 DOI: 10.1016/j.jad.2023.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/02/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND A growing body of data shows that schizophrenia (SCZ) and bipolar disorder (BD) have substantial metabolic risks; however, few studies have focused on bone metabolism. This study aimed to assess the prevalence and associated influencing factors of low bone mass and osteoporosis in SCZ and BD before pharmacological effects occur. METHODS 108 healthy controls (HCs) and drug-naïve individuals with SCZ (n = 56) and BD (n = 130) had their lumbar spine (L1-L4) and left femur (Neck/Trochanter/Ward's triangle) bone mineral density (BMD) determined using dual-energy X-ray absorptiometry. Besides, we measured bone turnover markers (BTMs) levels, including procollagen I N-terminal propeptide, osteocalcin, and C-terminal cross-linking telopeptide of type I collagen in different groups. RESULTS Individuals with SCZ and BD had significantly lower BMD and significantly higher prevalence of low bone mass and osteoporosis compared with HCs. In the main observation regions of the total lumbar (F = 18.368, p < 0.001) and left femur (F = 14.790, p < 0.001), BMD was lower in individuals with SCZ and BD than HCs, with SCZ showing lower BMD than BD. The osteocalcin (H = 11.421, p = 0.003) levels were significantly higher in SCZ and BD than HCs. Binary regression analysis showed that SCZ or BD was an independent risk factor for low bone mass and osteoporosis. In addition, sex, age, and BTMs also influenced the occurrence of low bone mass and osteoporosis. LIMITATIONS Cross-sectional study. CONCLUSION The results findings of the study might contribute to our understanding of the increased risk of bone metabolism in SCZ and BD. CLINICAL TRIAL REGISTRATION www.chictr.org.cn, identifier ChiCTR1900021379.
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Affiliation(s)
- Sujuan Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiaoqin Chen
- Qingdao Mental Health Center, Qingdao 266034, Shandong, China
| | - Yan Qiu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ziwei Teng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xuelei Xu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Hui Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Hui Xiang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Bolun Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Hui Yuan
- Department of Ultrasound Dltrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Haishan Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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İmre O, Karaağaç M, Caglayan C. Does Decreased Vitamin D Level Trigger Bipolar Manic Attacks? Behav Sci (Basel) 2023; 13:779. [PMID: 37754057 PMCID: PMC10525522 DOI: 10.3390/bs13090779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Bipolar disorder is a chronic psychiatric disorder with depression and manic episodes. It is one of the leading causes of disease-related disability worldwide. Despite the presence of various alternative drug options for bipolar disorder, some patients do not adequately benefit from the treatment. Therefore, possible underlying mechanisms need to be clarified. Recently, studies on the relationship between bipolar disorder and vitamin D (Vit D) have attracted attention. Although many studies have found an association between depression and Vit D deficiency, little is known about the relationship between manic episodes and Vit D. The aim of this study was to compare Vit D and related metabolites of bipolar manic episodes prior to treatment, bipolar remission after treatment, and healthy control groups. METHODS This case-control study consisted of 34 bipolar manic episode patients and 34 healthy controls. Disease activity was evaluated with the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Firstly, serum 25-hydroxy vitamin D (25-OHD), calcium (Ca) and phosphorus (P) levels of patients in the bipolar manic episode were measured and compared with healthy control. Secondly, serum 25-OHD, Ca and P levels in the euthymic periods of the same patients were measured and compared with healthy control. RESULTS Bipolar manic episode Vit D levels were lower when compared to healthy controls; while there was no difference in terms of Ca and P levels. There was no significant difference between the bipolar euthymic period patients and the healthy control group in terms of 25-OHD, Ca and P levels. CONCLUSION Our results demonstrated low serum Vit D concentrations in the acute manic episode of bipolar disorder. Decreased Vit D level may play a role in the onset of the manic episode, or malnutrition and insufficient sunlight during the manic episode may have caused Vit D deficiency. Future studies are needed to exclude potential confounding factors and to compare all mood episodes.
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Affiliation(s)
- Okan İmre
- Department of Psychiatry, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman 70200, Turkey
| | - Mustafa Karaağaç
- Department of Psychiatry, Karaman Training and Research Hospital, Karaman 70200, Turkey
| | - Cuneyt Caglayan
- Department of Medical Biochemistry, Faculty of Medicine, Bilecik Seyh Edebali University, Bilecik 11200, Turkey
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Azimi Manavi B, Stuart AL, Pasco JA, Hodge JM, Samarasinghe RM, Weerasinghe DK, Williams LJ. Use of antipsychotic medication and its relationship with bone mineral density: A population-based study of men and women. Front Psychiatry 2023; 13:1004366. [PMID: 36684026 PMCID: PMC9849889 DOI: 10.3389/fpsyt.2022.1004366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
Background Schizophrenia has been shown to be associated with reduced bone mineral density (BMD) and higher fracture risk. However, less is known whether antipsychotic treatment is associated with reduced BMD. Thus, we aimed to examine associations between antipsychotic use and BMD among men and women drawn from the general population. Methods This cross-sectional study involved 793 women and 587 men enrolled in the Geelong Osteoporosis Study (GOS). BMD was determined using dual-energy X-ray absorptiometry at the spine and hip. Information regarding socio-economic status (SES), current medication and/or supplementation use, lifestyle factors, and anthropometry was collected. Association between antipsychotic use and BMD was determined using linear regression after adjusting for potential confounders. Results Of the group, 33 women (4.2%) and 16 men (2.7%) currently used antipsychotics. Age was identified as an effect modifier in the association between antipsychotic use and BMD for women. Amongst women aged < 60 years, adjusted mean BMD was 11.1% lower at the spine [1.139 (95%CI 1.063-1.216) vs. 1.250 (95%CI 1.223-1.277) g/cm2, p = 0.005] for antipsychotic users compared to non-users. At the hip, age, weight, and smoking adjusted mean BMD was 9.9% lower [0.893 (95%CI 0.837-0.950) vs. 0.992 (95%CI 0.976-1.007) g/cm2, p < 0.001] for antipsychotic users in comparison with non-users. The pattern persisted following further adjustments. There was no association detected between antipsychotic use and BMD for women aged 60 years and over and for men. Conclusion Our data suggest that antipsychotic medication use is associated with reduced BMD in younger women but not older women or men.
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Affiliation(s)
- Behnaz Azimi Manavi
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Amanda L. Stuart
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Julie A. Pasco
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jason M. Hodge
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Geelong Centre for Emerging Infectious Diseases, Geelong, VIC, Australia
| | - Rasika M. Samarasinghe
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - D. Kavindi Weerasinghe
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J. Williams
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Li S, Qiu Y, Teng Z, Xu B, Tang H, Xiang H, Xu X, Chen J, Liu J, Wang B, Yuan H, Wu H. Research on biochemical indexes of bone metabolism in bipolar disorder: A cross-sectional study with newly diagnosed, drug-naïve patients. J Psychiatr Res 2022; 151:197-204. [PMID: 35500447 DOI: 10.1016/j.jpsychires.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/19/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In recent years, the metabolic abnormalities associated with bipolar disorder (BD) have attracted people's attention. However, clinical studies on bone metabolism in individuals with BD are unavailable. This study was designed to assess biochemical indexes of bone metabolism and related influencing factors. METHODS We measured bone turnover markers (BTMs), including procollagen Ⅰ N-terminal propeptide (PⅠNP), osteocalcin (OC) and C-terminal cross-linking telopeptide of type I collagen (CTX-I), and index of calcium and phosphorus metabolism in 100 drug-naïve individuals with BD (DSM-5) and 91 healthy volunteers. Besides, sociodemographic and clinical assessment were collected. Between-group comparisons and within subgroup analysis were performed. RESULTS The PⅠNP (t = 3.715, p < 0.001), OC (t = 2.117, p = 0.036), parathyroid hormone (PTH, t = 3.877, p < 0.001), vitamin D (t = 2.065, p = 0.041), insulin (t = 4.208, p < 0.001) and insulin resistance (t = 2.888, p = 0.004) levels in the drug-naive BD group was significantly higher than those in the healthy control (HC) group. The level of calcium (t = -2.124, p = 0.035) in the drug-naive BD group was significantly lower than that of the HC group. But OC and vitamin D loses statistical significance after Bonferroni correction. However, there was no significant difference in the CTX-I level between the two groups. There are gender differences in the level of BMTs in individuals with BD, but this phenomenon was not found in the HC subgroup. It is shown that diagnosed BD, gender, age and BMI may affect the PINP levels through multiple linear regression analysis. CONCLUSION The biochemical indexes of bone metabolism in drug-naive individuals with BD were more active than that of the healthy controls in a sample from the Chinese Han nationality. The finding provides new evidence for our understanding of bone metabolism in individuals with BD.
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Affiliation(s)
- Sujuan Li
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yan Qiu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ziwei Teng
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Baoyan Xu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hui Tang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hui Xiang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xuelei Xu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jindong Chen
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jieyu Liu
- Department of Ultrasound Dltrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bolun Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Yuan
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Haishan Wu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Li S, Qui Y, Teng Z, Chen J, Kang D, Tang H, Xiang H, Wu C, Tan Y, Wang L, Yang Y, Wang B, Wu H. Association Between Bipolar Disorder and Low Bone Mass: A Cross-Sectional Study With Newly Diagnosed, Drug-Naïve Patients. Front Psychiatry 2020; 11:530. [PMID: 32587534 PMCID: PMC7299052 DOI: 10.3389/fpsyt.2020.00530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medical comorbidities in people with mental disorders have recently gained more attention. People with bipolar disorder (BD) often have comorbid low bone mass, which is associated with increased fracture risk and related severe outcomes. However, few clinical studies on bone metabolism in BD patients are available. This study was designed to assess bone mineral density (BMD) and related influencing factors in a sample of newly diagnosed, drug-naïve individuals with BD and age- and sex-matched healthy controls. METHODS Sixty-one drug-naïve individuals with BD (DSM-V) and 95 healthy volunteers had their lumbar spine (L1-L4) and left hip (Neck/Troch/Ward's) BMD determined by dual-energy X-ray absorptiometry. Besides, sociodemographic and clinical assessment were collected. Between-group comparisons and within subgroup analysis were performed. RESULTS Drug-naïve patients with BD had significantly lower BMD in comparison to healthy controls in multiple sites (L1, L3, Neck, Troch, Ward's, and total hip). On subgroup analysis, overweight individuals with BD had higher bone mass, while females presented reduced BMD. Binary logistic regression showed that low BMD in multiple regions was associated with BD diagnosis, body mass index (BMI), gender, and age. CONCLUSION Drug-naïve individuals with BD have lower BMD when compared to an age- and gender-matched healthy control sample. Low BMI and female gender are factors associated with this outcome. The underlying pathological mechanisms of BD comorbid with osteoporosis should be further explored. CLINICAL TRIAL REGISTRATION www.chictr.org.cn, identifier ChiCTR190002137.
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Affiliation(s)
- Sujuan Li
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Yan Qui
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Ziwei Teng
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Dongyu Kang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Hui Tang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Hui Xiang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Chujun Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Yuxi Tan
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Lu Wang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Yanyi Yang
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bolun Wang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Haishan Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
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Radojkovic D, Pesic M, Radojkovic M, Dimic D, Vukelic Nikolic M, Jevtovic Stoimenov T, Radenkovic S, Velojic Golubovic M, Radjenovic Petkovic T, Antic S. Expression of prolactin receptors in the duodenum, kidneys and skeletal system during physiological and sulpiride-induced hyperprolactinaemia. Endocrine 2018; 62:681-691. [PMID: 30143940 DOI: 10.1007/s12020-018-1730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND AIM Hyperprolactinaemia in pregnancy leads to mild and reversible changes in the maternal skeletal system, and medicamentous hyperprolactinemia causes more detrimental effects. We conducted an experimental study to evaluate differences between Prlr gene expression in the duodenum, vertebrae and kidneys during physiological and medicamentous hyperprolactinaemia, which could influence calcium homeostasis. METHODS Experimental animals (18 weeks old, Wistar female rats) were divided as follows: group P (nine rats that were 3 weeks pregnant), group M (ten rats that were intramuscularly administrated sulpiride (10 mg/kg) twice daily for 3 weeks), and the control group (C, ten age-matched nulliparous rats, 18-week-old). Laboratory investigations included measurements of serum ionized calcium, phosphorus, urinary calcium and phosphorus excretion, osteocalcin (OC), serum procollagen type 1 N-terminal propeptide (P1NP), vitamin D, parathyroid hormone (PTH) and prolactin (PRL). Relative quantification of gene expression for prolactin receptors in the duodenum, vertebrae and kidneys was determined using real-time PCR. RESULTS Expression of the Prlr gene was significantly higher in the duodenum (p < 0.001) and lower in vertebrae (p < 0.001) and kidneys (p < 0.01) in rats with physiological hyperprolactinaemia (PHP) than in the control group. Significantly lower Prlr expression in the duodenum was verified (p < 0.001), along with increased Prlr gene expression in vertebrae (p < 0.001) and kidneys (p < 0.01), in rats with medicamentous hyperprolactinaemia (MHP) than in the C group. CONCLUSIONS Downregulation of Prlr gene expression in the duodenum may explain the diminished intestinal calcium absorption in medicamentous hyperprolactinaemia. Prolactin takes calcium from the skeletal system following increased Prlr gene expression in the vertebrae to maintain calcium homeostasis, which increases the harmful effect on bone metabolism compared to that of physiological hyperprolactinaemia.
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Affiliation(s)
- Danijela Radojkovic
- Medical Faculty, University of Nis, Blvd.dr Zoran Djindjic 81, 18000, Nis, Serbia.
- Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center Nis, Serbia Vojislav Ilic bb, 18000, Nis, Serbia.
| | - Milica Pesic
- Medical Faculty, University of Nis, Blvd.dr Zoran Djindjic 81, 18000, Nis, Serbia
- Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center Nis, Serbia Vojislav Ilic bb, 18000, Nis, Serbia
| | - Milan Radojkovic
- Medical Faculty, University of Nis, Blvd.dr Zoran Djindjic 81, 18000, Nis, Serbia
- Surgery Clinic, Clinical Center Nis, Vojislav Ilic bb, 18000, Nis, Serbia
| | - Dragan Dimic
- Medical Faculty, University of Nis, Blvd.dr Zoran Djindjic 81, 18000, Nis, Serbia
- Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center Nis, Serbia Vojislav Ilic bb, 18000, Nis, Serbia
| | | | | | - Sasa Radenkovic
- Medical Faculty, University of Nis, Blvd.dr Zoran Djindjic 81, 18000, Nis, Serbia
- Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center Nis, Serbia Vojislav Ilic bb, 18000, Nis, Serbia
| | - Milena Velojic Golubovic
- Medical Faculty, University of Nis, Blvd.dr Zoran Djindjic 81, 18000, Nis, Serbia
- Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center Nis, Serbia Vojislav Ilic bb, 18000, Nis, Serbia
| | | | - Slobodan Antic
- Medical Faculty, University of Nis, Blvd.dr Zoran Djindjic 81, 18000, Nis, Serbia
- Clinic of Endocrinology, Diabetes and Metabolic disorders, Clinical Center Nis, Serbia Vojislav Ilic bb, 18000, Nis, Serbia
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Chandrasekaran V, Brennan-Olsen SL, Stuart AL, Pasco JA, Berk M, Hodge JM, Williams LJ. Association between bipolar spectrum disorder and bone health: a meta-analysis and systematic review protocol. BMJ Open 2017; 7:e013981. [PMID: 28246138 PMCID: PMC5337658 DOI: 10.1136/bmjopen-2016-013981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Bipolar spectrum disorder is a chronic, episodic illness, associated with significant personal, social and economic burden. It is estimated to affect ∼2.4% of the population worldwide and is commonly associated with psychological and/or physiological comorbidities. Osteoporosis is one such comorbidity, a disease of bone that is asymptomatic until a fracture occurs. This systematic review attempts to capture, collate, assess and discuss the literature investigating the association between bipolar spectrum disorder and bone health. METHODS AND ANALYSIS We aim to identify articles that investigate the association between bipolar spectrum disorder and bone health in adults by systematically searching the MEDLINE, PubMed, OVID and CINAHL databases. Two independent reviewers will determine eligibility of studies according to predetermined criteria, and methodological quality will be assessed using a previously published scoring system. A meta-analysis will be conducted, and statistical methods will be used to identify and control for heterogeneity, if possible. If numerical syntheses are prevented due to statistical heterogeneity, a best evidence synthesis will be conducted to assess the level of evidence for associations between bipolar spectrum disorder and bone health. ETHICS AND DISSEMINATION Ethical permission will not be required for this systematic review since only published data will be used. This protocol will be registered with PROSPERO. Findings of the review will be published in a peer-reviewed scientific journal, and will be presented to clinical and population health audiences at national and international conferences.
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Affiliation(s)
| | - Sharon L Brennan-Olsen
- Deakin University, Geelong, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia
- Department of Medicine, The University of Melbourne-Western Precinct, St Albans, Australia
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Julie A Pasco
- Deakin University, Geelong, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia
| | - Michael Berk
- Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Barwon Health University Hospital, Geelong, Australia
| | - Jason M Hodge
- Deakin University, Geelong, Victoria, Australia
- Barwon Health University Hospital, Geelong, Australia
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Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015; 14:119-36. [PMID: 26043321 PMCID: PMC4471960 DOI: 10.1002/wps.20204] [Citation(s) in RCA: 512] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 - November 2014), combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, North Shore - Long Island Jewish Health SystemGlen Oaks, New York, NY, USA,Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of MedicineHempstead, New York, NY, USA,Psychiatric Neuroscience Center of Excellence, Feinstein Institute for Medical ResearchManhasset, New York, NY, USA,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of MedicineBronx, New York, NY, USA
| | - Johan Detraux
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of LeuvenB-3000 Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
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11
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de Kuijper G, Mulder H, Evenhuis H, Scholte F, Visser F, Hoekstra PJ. Determinants of physical health parameters in individuals with intellectual disability who use long-term antipsychotics. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2799-2809. [PMID: 23792429 DOI: 10.1016/j.ridd.2013.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/04/2013] [Accepted: 05/06/2013] [Indexed: 06/02/2023]
Abstract
Individuals with intellectual disability frequently use antipsychotics for many years. This may have detrimental health effects, including neurological symptoms and metabolic and hormonal dysregulation, the latter possibly affecting bone metabolism. There is large variability in the degree in which antipsychotic agents lead to these health problems. In the current study we investigated potential determinants of physical symptoms and biological parameters known to be associated with use of antipsychotics in a convenience sample of 99 individuals with intellectual disability who had used antipsychotics for more than one year for behavioural symptoms. We focused on extrapyramidal symptoms; on overweight and presence of components of the metabolic syndrome; and on elevated plasma prolactin and bone turnover parameters. As predictor variables, we used patient (sex, age, genetic polymorphisms, and severity of intellectual disability) and medication use (type and dosage) characteristics. We found extrapyramidal symptoms to be present in 53%, overweight or obesity in 46%, and the metabolic syndrome in 11% of participants. Hyperprolactineaemia and one or more elevated bone turnover markers were present in 17% and 25%, respectively. Higher age and more severe intellectual disability were associated with dyskinesia and a higher dosage of the antipsychotic drug was associated with parkinsonism. Less severe intellectual disability was related to higher Body Mass Index. Use of atypical antipsychotics was associated with higher diastolic blood pressure and elevated fasting glucose. Clinicians who prescribe antipsychotics in individuals with intellectual disability should carefully balance the potential benefits of prolonged treatment against the risk of health hazards associated with the use of antipsychotics.
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Affiliation(s)
- Gerda de Kuijper
- Vanboeijen, Intellectual Disability Centre, Assen, The Netherlands.
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