Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents

Chadi A Calarge; Stephanie D Ivins; Katherine J Motyl; Amal A Shibli-Rahhal; Michael M Bliziotes; Janet A Schlechte

doi:10.1177/2045125313487548

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Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents

Journal article

Open access

Peer reviewed

Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents

Chadi A Calarge, Stephanie D Ivins, Katherine J Motyl, Amal A Shibli-Rahhal, Michael M Bliziotes and Janet A Schlechte

Therapeutic advances in psychopharmacology, Vol.3(5), pp.278-293

10/2013

DOI: 10.1177/2045125313487548

PMCID: PMC3805387

PMID: 24167704

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Abstract

The increasing use of antipsychotics (APs) to treat pediatric psychiatric conditions has led to concerns over the long-term tolerability of these drugs. While the risk of cardiometabolic abnormalities has received most of the attention, preclinical and clinical studies provide preliminary evidence that APs can adversely impact bone metabolism. This would be most concerning in children and adolescents as suboptimal bone accrual during development may lead to increased fracture risk later in life. However, the potential mechanisms of action through which APs may impact bone turnover and, consequently, bone mineral content are not clear. Emerging data suggest that the skeletal effects of APs are complex, with APs directly and indirectly impacting bone cells through modulation of multiple signaling pathways, including those involving dopamine D 2 , serotonin, adrenergic, and prolactin receptors, as well as by affecting gonadotropins. Determining the action of APs on skeletal development is further complicated by polypharmacy. In children and adolescents, APs are frequently coprescribed with psychostimulants and selective serotonin reuptake inhibitors, which have also been linked to changes in bone metabolism. This review discusses the mechanisms by which APs may influence bone metabolism. Also covered are preclinical and pediatric findings concerning the impact of APs on bone turnover. However, the dearth of clinical information despite the potential public health significance of this issue underscores the need for further studies. The review ends with a call for clinicians to be vigilant about promoting optimal overall health in chronically ill youth with psychopathology, particularly when pharmacotherapy is unavoidable.

Reviews

bone metabolism

psychopathology

antipsychotics

hyperprolactinemia

osteoporosis

skeletal development

Details

Title: Subtitle: Possible mechanisms for the skeletal effects of antipsychotics in children and adolescents
Creators: Chadi A Calarge - Associate Professor, Departments of Psychiatry and Pediatrics, University of Iowa Carver College of Medicine, Psychiatry Research, 2-209 MEB, 500 Newton Road, Iowa City, IA 52242, USA
Stephanie D Ivins - University of Iowa Carver College of Medicine, Iowa City, IA, USA
Katherine J Motyl - Maine Medical Center Research Institute, Scarborough, ME, USA
Amal A Shibli-Rahhal - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Michael M Bliziotes - Oregon Health and Science University, Portland, OR, USA
Janet A Schlechte - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Therapeutic advances in psychopharmacology, Vol.3(5), pp.278-293
DOI: 10.1177/2045125313487548
PMID: 24167704
PMCID: PMC3805387
NLM abbreviation: Ther Adv Psychopharmacol
ISSN: 2045-1253
eISSN: 2045-1261
Publisher: SAGE Publications; Sage UK: London, England
Language: English
Date published: 10/2013
Academic Unit: Psychiatry; Medicine Administration; Internal Medicine
Record Identifier: 9984002399002771

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