Bone mineral density, prolactin, estradiol, testosterone levels and related research in male chronic patients with schizophrenia.

objectiveSchizophrenia is a severe mental disorder that often requires long-term oral administration of antipsychotic medication. Long-term use of antipsychotic drugs has been associated with alterations in bone mineral density (BMD) and hormone levels, increasing the risk of femoral neck fractures. This study sought to investigate changes in BMD and serum levels of prolactin (PRL), estradiol (E2), and testosterone (T) in male patients with chronic schizophrenia, and the correlations between BMD and these hormonal parameters.

methodsA total of 83 male schizophrenia patients (hospitalization duration ≥ 5 years) who were long-term inpatients at Yangzhou Wutaishan Hospital, and 62 age-matched male normal controls were enrolled. The Positive and Negative Syndrome Scale (PANSS) was used to assess the psychiatric symptoms of the schizophrenia patients. Quantitative Computed Tomography (QCT) was used to measure lumbar spine BMD in all participants. A chemiluminescence immunoassay was used to measure serum levels of PRL, E2, and T.

resultsMean BMD was significantly lower in the patient group (n = 83; 108.8 ± 26.9 mg/cm³) than in the control group (n = 62; 124.5 ± 27.1 mg/cm³ p < 0.01). Within the patient group, normal bone mass was observed in 32 cases (38.6%), osteopenia in 36 (43.4%), and osteoporosis in 15 (18.1%), while the control group comprised 39 cases (62.9%) with normal bone mass, 18 (29.0%) with osteopenia, and 5 (8.1%) with osteoporosis, representing a significant intergroup difference (p < 0.05). Furthermore, serum PRL concentrations were significantly higher in patients (28.8 ± 11.7 ng/ml) than in controls (13.6 ± 10.2 ng/ml; p < 0.01), whereas serum E2 concentrations were significantly lower in the patient group (55.2 ± 14.0 pmol/L) relative to controls (72.4 ± 16.6 pmol/L; p < 0.01). No significant difference was observed between the patient and control groups regarding serum T concentrations (13.5 ± 3.8 nmol/L vs. 14.6 ± 4.3 nmol/L; p > 0.05). Based on serum PRL concentrations, the patient group was further divided into a hyperprolactinemia subgroup and a normoprolactinemia subgroup. PRL levels differed significantly across these two subgroups and the control group (p < 0.01). BMD values were 102.5 ± 25.7 mg/cm³ in the hyperprolactinemic subgroup, 114.9 ± 26.9 mg/cm³ in the normoprolactinemic subgroup, and 124.5 ± 27.1 mg/cm³ in controls, with overall significant variation among the three (p < 0.01). Post-hoc LSD comparisons revealed that BMD in hyperprolactinemic patients was significantly lower than in both normoprolactinemic patients (p < 0.01) and controls (p < 0.01). Besides, serum E2 and T levels differed significantly across these three groups (p < 0.01). Correlation analysis showed that in the chronic male schizophrenia patient group, BMD was significantly negatively correlated with serum PRL (r = -0.366, p = 0.001), and significantly positively correlated with serum E2 (r = 0.248, p = 0.024) and T (r = 0.370, p = 0.001).

conclusionsBMD in male patients with chronic schizophrenia was significantly lower than that in the normal control group, indicating that schizophrenia patients on long-term antipsychotic medication may be more susceptible to increased bone metabolism, osteopenia, or osteoporosis compared to the general population. A potential contributing factor to the decrease in BMD in chronic male schizophrenia patients may be the elevated serum PRL levels, which could lead to alterations in estrogen levels within the body, thereby further affecting bone metabolism. There may be significant correlations between serum PRL, T, E2 levels, and BMD in male schizophrenia patients. CLINICAL TRIAL NUMBER: Not applicable.