Antipsychotic use and risk of low-energy fractures in people with schizophrenia

Schizophrenia BulletinScott Cunningham MD PhD, et al. | November 14, 2022



Schizophrenia is associated with several metabolic and cardiovascular conditions, including imbalanced bone metabolism. As a result, decreased bone mineral density is common in schizophrenics. In addition to an unhealthy lifestyle, decreased bone mineral density and an increased risk of fractures, can result from use of prolactin-increasing anti-psychotics, as reported in the current study.

This was a nested case-control study. Data were obtained from nationwide registers in Finland. Patients with schizophrenia, 16-85 years of age, who were prescribed prolactin-increasing and -sparing medications with and without LEFs were studied.

A total of 4960 patients with schizophrenia who sustained LEFs while prescribed prolactin-increasing and -sparing anti-psychotics and 24,451 patients with schizophrenia who did not sustained LEFs were studied.

Patients who were exposed to prolactin-increasing anti-psychotics for > 4 years or > 1000 defined daily doses were at increased risk for a LEF (adjusted odds ratio [aOR] = 1.22-1.38 and aOR = 1.21-1.64, respectively).

There was no association between prolactin-sparing anti-psychotics and LEFs, except at extreme doses.