Effects of long-term combination treatment with valproate and atypical antipsychotics on bone mineral density and bone metabolism in premenopausal patients with bipolar disorder: A preliminary study

Jaewon Yang, Sook Haeng Joe, Moon-Soo Lee, Young-Hoon Ko, In Kwa Jung, Seung Hyun Kim

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7 Citations (Scopus)

Abstract

Objective We investigated bone mineral density (BMD) and bone metabolism in female bipolar patients who were undergoing long-term treatment with valproate combined with a low-dose atypical antipsychotic. Methods Nineteen premenopausal women with bipolar disorder who were treated with valproate combined with atypical antipsychotics for at least 2 years were evaluated. The BMD was measured at lumbar spine and femur sites using dual-energy X-ray absorptiometry (DEXA). The biochemical markers of bone turnover and circulating levels of gonadal hormones were assessed. Subjects with abnormal DEXA scans were compared to those with normal scans. Results Nine (47%) of nineteen subjects showed osteopenia or osteoporosis. The T-score for subjects with abnormal DEXA scans was -1.988. Decreased BMD was more prominent in the proximal femur than in the lumbar spine. Subjects with abnormal DEXA scans had high phosphorus and low testosterone levels relative to subjects with normal scans (p=0.008 and p=0.028, respectively). There was a significant negative correlation between phosphorus, osteocalcin, and femur neck BMD (p<0.05). However, multivariate analysis did not show a significant association between femur and lumbar BMD and biochemical markers of bone turnover. Conclusion Long-term treatment with valproate combined with low-dose atypical antipsychotics may adversely affect BMD in premenopausal women with bipolar disorder. A prospective, controlled-study with a larger population is warranted, and assessment of BMD and bone metabolism should be taken into consideration in long-term therapy with valproate and atypical antipsychotics.

Original languageEnglish
Pages (from-to)256-261
Number of pages6
JournalPsychiatry Investigation
Volume8
Issue number3
DOIs
Publication statusPublished - 2011 Sep 1

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Valproic Acid
Bipolar Disorder
Bone Density
Antipsychotic Agents
Bone and Bones
Photon Absorptiometry
Femur
Bone Remodeling
Phosphorus
Therapeutics
Spine
Biomarkers
Gonadal Hormones
Metabolic Bone Diseases
Femur Neck
Osteocalcin
Osteoporosis
Testosterone
Multivariate Analysis
Prospective Studies

Keywords

  • Bipolar disorder
  • Bone density
  • Bone metabolism
  • Females
  • Valproate

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

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title = "Effects of long-term combination treatment with valproate and atypical antipsychotics on bone mineral density and bone metabolism in premenopausal patients with bipolar disorder: A preliminary study",
abstract = "Objective We investigated bone mineral density (BMD) and bone metabolism in female bipolar patients who were undergoing long-term treatment with valproate combined with a low-dose atypical antipsychotic. Methods Nineteen premenopausal women with bipolar disorder who were treated with valproate combined with atypical antipsychotics for at least 2 years were evaluated. The BMD was measured at lumbar spine and femur sites using dual-energy X-ray absorptiometry (DEXA). The biochemical markers of bone turnover and circulating levels of gonadal hormones were assessed. Subjects with abnormal DEXA scans were compared to those with normal scans. Results Nine (47{\%}) of nineteen subjects showed osteopenia or osteoporosis. The T-score for subjects with abnormal DEXA scans was -1.988. Decreased BMD was more prominent in the proximal femur than in the lumbar spine. Subjects with abnormal DEXA scans had high phosphorus and low testosterone levels relative to subjects with normal scans (p=0.008 and p=0.028, respectively). There was a significant negative correlation between phosphorus, osteocalcin, and femur neck BMD (p<0.05). However, multivariate analysis did not show a significant association between femur and lumbar BMD and biochemical markers of bone turnover. Conclusion Long-term treatment with valproate combined with low-dose atypical antipsychotics may adversely affect BMD in premenopausal women with bipolar disorder. A prospective, controlled-study with a larger population is warranted, and assessment of BMD and bone metabolism should be taken into consideration in long-term therapy with valproate and atypical antipsychotics.",
keywords = "Bipolar disorder, Bone density, Bone metabolism, Females, Valproate",
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T1 - Effects of long-term combination treatment with valproate and atypical antipsychotics on bone mineral density and bone metabolism in premenopausal patients with bipolar disorder

T2 - A preliminary study

AU - Yang, Jaewon

AU - Joe, Sook Haeng

AU - Lee, Moon-Soo

AU - Ko, Young-Hoon

AU - Jung, In Kwa

AU - Kim, Seung Hyun

PY - 2011/9/1

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N2 - Objective We investigated bone mineral density (BMD) and bone metabolism in female bipolar patients who were undergoing long-term treatment with valproate combined with a low-dose atypical antipsychotic. Methods Nineteen premenopausal women with bipolar disorder who were treated with valproate combined with atypical antipsychotics for at least 2 years were evaluated. The BMD was measured at lumbar spine and femur sites using dual-energy X-ray absorptiometry (DEXA). The biochemical markers of bone turnover and circulating levels of gonadal hormones were assessed. Subjects with abnormal DEXA scans were compared to those with normal scans. Results Nine (47%) of nineteen subjects showed osteopenia or osteoporosis. The T-score for subjects with abnormal DEXA scans was -1.988. Decreased BMD was more prominent in the proximal femur than in the lumbar spine. Subjects with abnormal DEXA scans had high phosphorus and low testosterone levels relative to subjects with normal scans (p=0.008 and p=0.028, respectively). There was a significant negative correlation between phosphorus, osteocalcin, and femur neck BMD (p<0.05). However, multivariate analysis did not show a significant association between femur and lumbar BMD and biochemical markers of bone turnover. Conclusion Long-term treatment with valproate combined with low-dose atypical antipsychotics may adversely affect BMD in premenopausal women with bipolar disorder. A prospective, controlled-study with a larger population is warranted, and assessment of BMD and bone metabolism should be taken into consideration in long-term therapy with valproate and atypical antipsychotics.

AB - Objective We investigated bone mineral density (BMD) and bone metabolism in female bipolar patients who were undergoing long-term treatment with valproate combined with a low-dose atypical antipsychotic. Methods Nineteen premenopausal women with bipolar disorder who were treated with valproate combined with atypical antipsychotics for at least 2 years were evaluated. The BMD was measured at lumbar spine and femur sites using dual-energy X-ray absorptiometry (DEXA). The biochemical markers of bone turnover and circulating levels of gonadal hormones were assessed. Subjects with abnormal DEXA scans were compared to those with normal scans. Results Nine (47%) of nineteen subjects showed osteopenia or osteoporosis. The T-score for subjects with abnormal DEXA scans was -1.988. Decreased BMD was more prominent in the proximal femur than in the lumbar spine. Subjects with abnormal DEXA scans had high phosphorus and low testosterone levels relative to subjects with normal scans (p=0.008 and p=0.028, respectively). There was a significant negative correlation between phosphorus, osteocalcin, and femur neck BMD (p<0.05). However, multivariate analysis did not show a significant association between femur and lumbar BMD and biochemical markers of bone turnover. Conclusion Long-term treatment with valproate combined with low-dose atypical antipsychotics may adversely affect BMD in premenopausal women with bipolar disorder. A prospective, controlled-study with a larger population is warranted, and assessment of BMD and bone metabolism should be taken into consideration in long-term therapy with valproate and atypical antipsychotics.

KW - Bipolar disorder

KW - Bone density

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KW - Valproate

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