Psychopharmaka und Knochen

Psychotropic drugs from the group of antidepressants, neuroleptics (antipsychotics) and lithium preparations have different effects on bone. They can contribute to the development of osteoporosis with an increased fracture risk (antidepressants, neuroleptics), but can also have a bone-protective effect (lithium preparations). Antidepressants cause an increase in serotonin and/or norepinephrine in the synapses. In the bone, they cause a decrease in bone mineral density and, consequently, an increase in the risk of fracture. As dopamine receptor antagonists, neuroleptics lead to hyperprolactinemia and thus to secondary hypogonadism; this and a direct negative impact on osteoblasts lead to a decrease in bone mineral density and an increased fracture risk. Lithium salts, on the other hand, are bone protective. Therapy with lithium preparations is associated with a decrease in the risk of fractures. When treating with psychotropic drugs, especially antidepressants or neuroleptics, bone health should also be taken into account, especially in patients at risk (age, tendency to fall, comedication, pre-existing osteoporosis, fractures). The increased tendency to fractures during psychotropic drug therapy is usually multifactorial, since in addition to the direct negative effects of the medication on the bone, there can also be an increased tendency to fall and a decrease in bone mineral density due to the mental illness per se. Psychotropic drug therapy should be optimized taking into account potential side effects, which also include the increased risk of fractures.