Serum prolactin and bone mineral density in schizophrenia- a systematic review
John Lally 1, 2, 3*, Abdullah Bin Sahl 2, Kieran C Murphy 2, Fiona Gaughran 1, 4, Brendon Stubbs 5, 6
1Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK, 2Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland, 3St Vincent’s Hospital Fairview, Dublin, Ireland, 4National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom, 5Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, 6Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
Received: January 14, 2019; Revised: February 16, 2019; Accepted: March 8, 2019; Published online: March 8, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objectives
The relationship between serum prolactin and bone mineral density BMD) in schizophrenia is unclear. We conducted a literature review of databases from inception until December 2018 for cross-sectional, case-control, prospective and retrospective studies analysing correlations between serum prolactin and BMD measured using dual energy X-ray absorptiometry (DXA) or quantitative ultrasound (QUS) at any skeletal site in people with schizophrenia.
Methods
Data was summarised with a best evidence synthesis.
Results
This review identified 15 studies (1 longitudinal study, 10 cross-sectional and 4 case-control studies) (n=1360 individuals with a psychotic disorder; mean age 45.1 (SD=9.4) years, 54.6% (n=742) female, mean illness duration 17.7 (SD=11.3) years) assessing the relationship between serum prolactin and BMD in schizophrenia. There was a statistically significant inverse correlation between serum prolactin and BMD identified in eight of the studies (53% of all studies), suggesting mixed evidence for an association between serum prolactin and BMD. Of those studies which identified a significant inverse correlation between serum prolactin and BMD (n=5), 52.1% (n=152) of patients were treated with prolactin raising antipsychotics, compared to 48.9% (n=140) of patients in those studies which did not identify a significant correlation between prolactin and BMD
Available studies cannot resolve the link between excess prolactin and reduced BMD in schizophrenia. Future studies should be longitudinal in design and combine measures of serum prolactin along with other risk factors for reduced BMD such as smoking and vitamin D and sex hormone levels in assessing the relationship between prolactin and BMD in schizophrenia.
Keywords: Psychosis, hyperprolactinemia, hormones, fracture, bone density


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