title: Bone remodeling, bone mass and weight gain in patients with stabilized schizophrenia in real-life conditions treated with long-acting injectable risperidone.
abstract: BACKGROUND
  Prolactin-raising antipsychotics, risperidone (antidopaminergic activity), may be associated with low bone mass. On the other hand, risperidone may cause an increase in body weight thought to be favorable for bone.
  
  
  OBJECTIVE
  (1) To determine bone remodeling parameters and bone mass in patients with schizophrenia on long-term treatment with long-acting injectable risperidone (LAIR) in naturalistic settings, and (2) to evaluate the change in body weight, metabolic profile and neuroendocrine status in these patients.
  
  
  METHODS
  This was a prospective, cross-sectional study.
  
  
  METHODS
  Patients included 26 outpatients with controlled schizophrenia in real-life conditions (age 31.3 ± 1.3 years, BMI 28.1 ± 1.0) on long-term maintenance therapy with LAIR for a mean of 18.0 ± 1.6 months (range 6-36) with a mean dose of 38 ± 2 mg. 35 subjects matched for sex, age, BMI and education served as healthy controls.
  
  
  METHODS
  Serum osteocalcin, C-terminal telopeptide of type I collagen (CTx), vitamin D, leptin, prolactin, sex steroids, and parathyroid hormone were assessed. Indices of insulin sensitivity and resistance were determined following an oral glucose tolerance test (OGTT). Bone mineral density (BMD) was measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN).
  
  
  RESULTS
  Mild to moderate hyperprolactinemia (1,000-2,000 mU/l) was associated with asymptomatic hypogonadism. Prolactin values >2,000 mU/l occurred in a few female patients. Hypogonadism leads to a slight increase (upper limit of normal) in bone resorption marker (CTx) in patients with schizophrenia (p = 0.023). As for bone mass, although lower at the spine than in healthy subjects, it did not reach statistical significance (p = 0.094), while at the FN, BMD was not different from healthy subjects. Body weight increased on average 8.7 ± 1.6 kg in more than 50% of patients. Leptin levels adjusted for BMI in females were significantly higher in patients than in healthy female subjects (p = 0.018), while in males there was no difference between the groups (p = 0.833). A high prevalence of low vitamin D levels and more current smokers were found in patients with schizophrenia. As for the metabolic profile during treatment with risperidone, the low Matsuda index of insulin sensitivity (p = 0.039) confirmed insulin resistance in these patients.
  
  
  CONCLUSIONS
  A potential long-term consequence of asymptomatic hypogonadism due to risperidone-induced hyperprolactinemia might cause a slight rise in bone resorption marker (CTx). On the other hand, by increasing body weight, risperidone could have a protective effect on the bone and thus no change in bone mass was recorded when compared with healthy controls.
authors: Clinic for Endocrinology, Clinical Center of Serbia, Belgrade, Serbia.
authors: Mirjana
authors: M
authors: Doknic
authors: Nadja P
authors: NP
authors: Maric
authors: Dubravka
authors: D
authors: Britvic
authors: Sandra
authors: S
authors: Pekic
authors: Aleksandar
authors: A
authors: Damjanovic
authors: Dragana
authors: D
authors: Miljic
authors: Marko
authors: M
authors: Stojanovic
authors: Zoran
authors: Z
authors: Radojicic
authors: Miroslava
authors: M
authors: Jasovic Gasic
authors: Vera
authors: V
authors: Popovic
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000494:pharmacology; D015519:Bone Density / Q000187:drug effects; D016723:Bone Remodeling / Q000187:drug effects* / Q000502:physiology; D001842:Bone and Bones / Q000187:drug effects* / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007267:Injections; D060046:Maintenance Chemotherapy; D008297:Male; D009929:Organ Size / Q000187:drug effects; D018967:Risperidone / Q000008:administration & dosage* / Q000494:pharmacology; D012559:Schizophrenia / Q000188:drug therapy* / Q000473:pathology / Q000534:rehabilitation; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D018967:Risperidone