Appendix
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Psychiatry

Atypical Antipsychotic Effect on Bone Mineral Density

Atypical antipsychotic use in psychiatric patients, particularly children and adolescents (C/A), has increased recently. Autism spectrum, bipolar, psychosis, and other psychiatric or emotional disorders are psychiatric conditions that need Antipsychotics today. There is limited data on the long-term safety of Antipsychotics on growth and development, specifically on bone metabolism. This activity outlines the clinical presentation, evaluation, and management by an interprofessional team of atypi

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • The US-FDA warns about this adverse effect in the prescribing information.
  • Osteoporosis causes 1 fracture every 3 seconds.
  • Typical clinical presentation of impaired bone mineral density includes diffuse bone pain, tenderness, muscle weakness, and fragility fractures.
  • The neck of the femur and wedged vertebral fractures are classic osteoporosis.
  • High morbidity and mortality are associated with a bone fracture in psychiatric patients.
  • DXA is the primary tool for assessing bone density.
  • QCT measures the bone volume and accurately assesses volumetric BMD, and it can differentiate between cortical and trabecular bone.
  • Peripheral (PQCT) is an alternative technique with less radiation risk and is more convenient for children.
  • Prolactin levels should be checked at baseline and then regularly annually, and should be normalized promptly.
  • evaluate calcium and phosphorus intake, sun exposure, vitamin D levels, bone turnover markers such as alkaline phosphatase, and physical activity.
  • Proactive preventive measures to improve BMD in psychiatric patients chronically treated with antipsychotics, including lifestyle modification, a fall prevention program, monitoring prolactin level, vitamin D supplement, avoiding smoking, and alcohol exposure.
  • The antipsychotic dose should be adjusted if clinically safe and suitable.
  • A switch to antipsychotics without prolactin-elevating qualities may be a useful alternative and or add-on antiresorptive medications.
  • Medications such as bisphosphonates, raloxifene, denosumab, and glucagon-like peptide-1 (GLP-1) are currently used in clinical practice.
  • Moreover, teriparatide, anabolic, and hormonal replacement therapy are other options to improve bone mineral density.
  • A switch to antipsychotics without prolactin-elevating qualities may be a useful alternative and or add-on antiresorptive medications.
  • Consultation with a psychiatrist or a pharmacist can assist with antipsychotic selection, guide the ideal dosing, and explore safer alternatives.
  • Antipsychotic-exposed patients should have frequent screening, especially with concomitant hyperprolactinemia.
  • Prolactin levels should be checked at baseline and then regularly annually, and should be normalized promptly.
  • The risk of complications can be minimized with lifestyle changes, exercise, and a well-balanced diet.
  • Antipsychotics can cause various metabolic and hormonal side effects, including obesity, dyslipidemia, uncontrolled diabetes mellitus, metabolic syndrome, QTc abnormality, and the extrapyramidal sequelae, myocarditis, bone marrow suppression, cataracts, hyperprolactinemia with or without hypogonadism, and sexual adverse effects.
  • Impaired bone mineral density, with or without bone fracture, is one of the potential antipsychotic side effects that the clinician has not thoroughly studied and has missed.
  • review
    Atypical Antipsychotic Effect on Bone Mineral Density. StatPearls [Internet] — Wisam Al Jumaili, Shailesh B. Jain — StatPearls Publishing, 2022

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov