title: Bone mineral density as a marker of cumulative endogenous estrogen exposure: relationship to background genetic risk of psychotic disorder.
abstract: BACKGROUND
  Alterations in bone mineral density (BMD) in patients with psychotic disorder may reflect the effect of treatment (disease effect observed in patients but not their siblings) or, as an intermediate marker of cumulative endogenous estrogen exposure, alterations in the neuroprotective effect of estrogen in the brain (vulnerability effect observed in patients and siblings).
  
  
  METHODS
  Dual X-ray absorptiometry (DEXA) scans were acquired in 62 patients with a psychotic disorder, 67 non-psychotic siblings of patients with a psychotic disorder, and 48 controls. BMD (g/cm(2)), Z-scores and T-scores were measured in the lumbar spine and proximal femur. Associations between group and BMD were investigated with multilevel random regression analyses. Group×sex interactions and effects of antipsychotic medication (AP) on BMD were examined.
  
  
  RESULTS
  Group was not associated with BMD outcome measures, although patients had consistently lower BMD measures compared to both siblings and controls. There were no significant group×sex interactions, but stratified analyses showed that BMD measures in female patients were significantly lower in comparison to female controls and siblings (e.g. total femoral BMD, P vs. C: B=-0.100, p=0.010; P vs. S: B=-0.104, p=0.008). After excluding female patients who used prolactin-raising AP, the effect was attenuated (e.g. total femoral BMD, P vs. C: B=-0.073, p=0.072; P vs. S: B=-0.085, p=0.051). In men, there were no significant BMD differences between patients and controls.
  
  
  CONCLUSIONS
  Familial risk of psychotic disorder was not associated with BMD. Instead, decreased BMD in the femur may reflect treatment effects or non-familial risk associated with low cumulative endogenous estrogen levels in women.
authors.affiliation: Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van der Leeuw
authors.forename: P
authors.initials: P
authors.lastname: Habets
authors.forename: P
authors.initials: P
authors.lastname: Domen
authors.forename: M
authors.initials: M
authors.lastname: van Kroonenburgh
authors.forename: J
authors.initials: J
authors.lastname: van Os
authors.forename: M
authors.initials: M
authors.lastname: Marcelis
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000453:epidemiology; D004967:Estrogens / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology; D011618:Psychotic Disorders / Q000188:drug therapy / Q000235:genetics* / Q000503:physiopathology*; D012737:Sex Factors; D013116:Spinal Cord / Q000473:pathology; D013472:Sunlight; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D004967:Estrogens