Bone mineral density in male schizophrenia patients: a review

Decreased bone mineral density (BMD) has been documented frequently in female patients with schizophrenia receiving antipsychotic therapy with potent dopamine D(2) antagonists, but there has been much less coverage of this issue in male patients with schizophrenia despite the fact that older males who sustain osteopenia-related hip fractures have subsequently greater mortality than females.

A Medline search was performed for the years 1966-2004 using the following search terms: "osteopenia or osteoporosis or bone density or bone mineral density," combined with "schizophrenia or psychosis or antipsychotic."

The search yielded 8 studies which provided data on bone mineral density in male patients with schizophrenia, of which 2 were case reports, and 3 were controlled studies. Hormonal measures were present in 6 studies. In every study where such information was provided, the patients with schizophrenia had significantly lower BMD than nonschizophrenic controls or population norms, with the prevalence of osteopenia ranging from 40-72%.

Low BMD and corresponding osteopenia or osteoporosis may be a highly prevalent but significantly underdiagnosed medical condition among male schizophrenia patients. Psychiatrists should consider BMD screening among older males who have received chronic antipsychotic therapy with antipsychotics expected to achieve high levels of postsynaptic D(2) antagonism.