title: Changes in biomarkers of bone turnover in an aripiprazole add-on or switching study.
abstract: BACKGROUND
  The association between mental illness and osteoporosis and fractures is particularly pronounced in psychotic disorders. Antipsychotic use has previously been described to affect bone density.
  
  
  METHODS
  A 52-week follow-up of patients switched to aripiprazole or with aripiprazole added on, conducting a specific analysis of markers of bone turnover: urinary NTX (a biomarker of bone resorption) and serum BSAP (a biomarker of bone formation). Baseline and serial measurements of bone markers NTX, BSAP and of hormones prolactin, oestrogen and testosterone were done at weeks 0 and 1, 2, 6, 12, 26 and 52, respectively.
  
  
  RESULTS
  NTX concentration reduced over time but this did not reach significance in the whole group (log-NTX: β=-0.0012, p=0.142). For BSAP the addition of or replacement with aripiprazole produced a significant reduction (log-BSAP: β=-0.00039, p=0.002). Analysis with prolactin similarly showed a significant reduction (log-prolactin: β=-0.0024, p<0.001); other hormones did not change significantly. Sensitivity analysis to compare the switchers to aripiprazole versus the "add-on" showed that the former group had a significant reduction in NTX.
  
  
  CONCLUSIONS
  We found that switching to aripiprazole was associated with changes in molecular biomarkers of bone resorption, indicating a more favourable profile for bone health.
authors.affiliation: Department of Psychiatry, University of Alberta, Canada. Electronic address: rohitlodhi@gmail.com.
authors.forename: Rohit J
authors.initials: RJ
authors.lastname: Lodhi
authors.affiliation: Royal Bournemouth Hospital, UK.
authors.forename: Salaj
authors.initials: S
authors.lastname: Masand
authors.affiliation: Lewisham Primary Care Psychological Therapies Service, Deptford, UK; COAST Team, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Amna
authors.initials: A
authors.lastname: Malik
authors.affiliation: Department of Psychiatry, Northern Ontario School of Medicine, Sudbury, Ontario, Canada; COAST Team, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Kuppuswami
authors.initials: K
authors.lastname: Shivakumar
authors.affiliation: COAST Team, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Victoria D M
authors.initials: VD
authors.lastname: McAllister
authors.affiliation: Trinity Centre for Health Sciences, Psychiatry, Ireland.
authors.forename: Veronica
authors.initials: V
authors.lastname: O'Keane
authors.affiliation: Department of Psychiatry, University of Alberta, Canada.
authors.forename: Leah C
authors.initials: LC
authors.lastname: Young
authors.affiliation: The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, UK.
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Heald
authors.affiliation: Department of Clinical Biochemistry, King's College Hospital, London.
authors.forename: Roy A
authors.initials: RA
authors.lastname: Sherwood
authors.affiliation: Department of Psychiatry, University of Alberta, Canada; COAST Team, South London and Maudsley NHS Foundation Trust, London, UK; Department of Medical Genetics, University of Alberta, Canada; Kings College London, MRC SGDP Centre, UK.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Aitchison
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068180:Aripiprazole / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D001714:Bipolar Disorder / Q000188:drug therapy / Q000378:metabolism; D016723:Bone Remodeling / Q000187:drug effects* / Q000502:physiology*; D004967:Estrogens / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D051757:PAX5 Transcription Factor / Q000097:blood; D011388:Prolactin / Q000378:metabolism; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000188:drug therapy / Q000378:metabolism; D012559:Schizophrenia / Q000188:drug therapy / Q000378:metabolism; D012680:Sensitivity and Specificity; D013739:Testosterone / Q000378:metabolism; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D015415:Biomarkers; D004967:Estrogens; D051757:PAX5 Transcription Factor; C497281:PAX5 protein, human; D013739:Testosterone; D000068180:Aripiprazole; D011388:Prolactin
keywords: Antipsychotics; Aripiprazole; Bone markers; Ntxc