Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Antipsychotics and Bone Density
Penny Kraemer, Regional Pharmacist Manager, Ward MM
Antipsychotics may be prescribed for management of schizophrenia, as mood stabilisers or for the management of behavioural and psychological symptoms of dementia (BPSD). Risperidone is the only antipsychotic approved in Australia for the management of BPSD.
- Prolactin-sparing – including olanzapine, quetiapine, aripiprazole, ziprasidone and clozapine, and
- Prolactin-raising – including all first-generation antipsychotics, amisulpride, risperidone and paliperidone
- Elevated prolactin levels (hyperprolactinaemia) can result in decreased bone density and associated risk of fractures including hip fracture. 15-20% people die within 12 months of sustaining a hip fracture.
- The dose of the antipsychotic is not correlated with the prolactin level and current evidence suggests that postmenopausal women and older men may be more vulnerable to hyperprolactinemia-related low bone density than premenopausal women and younger men.
- Patients with dementia have up to an 8-fold higher risk of falling, and a particularly high risk of sustaining multiple falls, compared with those without dementia. Long term use of risperidone in these patients may increase the risk of hip fracture.
- Regular review of bone density is recommended for patients who require long term use of an antipsychotic that is prolactin-raising. In the management of BPSD risperidone treatment should not exceed 12 weeks and it should be used to treat persistent agitation or aggression only if the symptoms are unresponsive to non-pharmacological approaches.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to email@example.com.