{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzmsc1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzmsc1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;10\\\/4\\\/14-b\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;10\\\/4\\\/14-b\u0022}],\u0022ac\u0022:{\u0022spmdc;10\\\/4\\\/14-b\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;10\\\/4\\\/14-b\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe use of certain psychotropic medications may be enhancing an already high underlying risk for osteoporosis, according to several studies. Psychotropic agents have been linked to fractures, and antidepressants have been associated with low bone mineral density. The studies that were presented validate these earlier findings and suggest that many patients may already be at high risk for bone disease.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMetabolic Bone Disease Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMetabolic Bone Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychopharmacology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe use of certain psychotropic medications may be enhancing an already high underlying risk for osteoporosis, according to several studies that were presented at the American Psychiatric Association 2010 Annual Meeting.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPsychotropic agents have been linked to fractures, and antidepressants have been associated with low bone mineral density (BMD). The studies that were presented validate these earlier findings and suggest that many patients may already be at high risk for bone disease.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn a large study from Canada, osteoporosis was found to be associated with the use of selective serotonin reuptake inhibitors (SSRIs), mood stabilizers other than lithium, and benzodiazepines but that the use of tricyclic antidepressants was protective.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA 40% increased risk for low BMD with SSRIs and a 37% reduced risk with tricyclic antidepressants were reported by James Bolton, MD, University of Manitoba, Winnipeg, Canada.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EData were derived from Manitoba\u0027s health care database, which captures all physician contacts and diagnoses, all prescribed medications, all hospitalizations, and census data, which were then linked to data from the Manitoba Bone Density Program, a clinical database of information from dual-energy X-ray absorptiometry scans (DXA).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EInvestigators were able to identify 7994 osteoporosis cases from database records covering the period 2000 to 2007. Cases were defined as persons with a T-score of \u22122.5 or lower at one of four sites (trochanter, femoral neck, total hip, or lumbar spine). Controls were 23,928 subjects who were matched for gender, age, and ethnicity. Three controls were matched for each osteoporosis case.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Bolton and colleagues assessed all psychotropic medications that were prescribed, all mental disorders that were diagnosed, and nearly 20 confounders (eg, body mass index, medical comorbidity, estrogen use, and bisphosphonate use).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe adjusted odds ratio was 1.39 for SSRIs (95% CI, 1.21 to 1.59), 1.35 for nonlithium mood stabilizers (eg, anticonvulsants) (95% CI, 1.10 to 1.66), 1.10 for benzodiazepines (95% CI, 1.01 to 1.20), and 0.63 for tricyclic antidepressants (95% CI, 0.56 to 0.72). Dr. Bolton suggested that perhaps because sample sizes were smaller, the odds ratio for lithium was 0.57, but the confidence interval crossed 1.0 (95% CI, 0.29 to 1.12). The same was true for typical antipsychotics (OR, 1.20; 95% CI, 0.81 to 1.77) and for atypical antipsychotics (OR, 1.55; 95% CI, 0.87 to 1.97). Other antidepressants had an odds ratio of 1.08 (95% CI, 0.91to 1.27).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EMental disorders themselves also had statistically significant osteoporotic effects, including dementia (HR, 1.34; 95% CI, 1.04 to 1.72), schizophrenia (HR, 1.92; 95% CI, 1.11 to 3.33), and alcohol dependence (HR, 1.53; 95% CI, 1.01 to 2.32). Risk was reduced, interestingly, with depression, which carried an odds ratio of 0.85 (95% CI, 0.75 to 0.95). Bipolar disorder and drug abuse or dependence was not significantly associated with osteoporosis.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EDr. Bolton concluded, \u201cSSRIs, anticonvulsant mood stabilizers, and benzodiazepines are associated with osteoporotic changes in bone, independent of the effects of mental disorders and other confounders, and tricyclic antidepressants appear to be protective.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EA study by Barbara Gracious, MD, University of Rochester Medical Center, Rochester, NY, suggested that women who are treated for depression\u2014and presumably are receiving SSRIs\u2014have an underlying risk for osteoporosis that may be neglected.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThe majority of study subjects was disabled by depression and had been on maintenance therapy with SSRIs for many years. They also had exposure to prolactin-elevating antipsychotic medications (associated with reduced estrogen and testosterone). \u201cWe found the risk factor burden of these patients was huge,\u201d said Barbara Gracious, MD.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EThis study systematically examined osteoporosis risk factors via personalized screening to determine if osteoporosis prevention is warranted in midlife mood-disordered patients. Nineteen patients, mean age 47 years and 94% female, were recruited from a university psychiatric partial hospitalization program and an urban university neighborhood family medical center. The Mini-International Neuropsychiatric Interview (MINI) confirmed the Primary Axis 1 diagnosis of major depression and captured comorbid mental disorders. Structured interviews provided demographics, history, lifestyle, and medication risk.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EThe average patient was found to have 19 risk factors for osteoporosis. The most prevalent iatrogenic risk factors were history of SSRI use (89%), history of major surgery (89%), and history of prolactin-elevating antipsychotic exposure (68%). Prevalent lifestyle factors were decreased weight-bearing exercise (76%), low vitamin D levels (64%), alcohol use (59%), cigarette smoking (53%), and excess salt intake (41%).\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EMany had a family history of fractures (53%) or osteoporosis (29%) and irregular menstruation cycles (35%). Only about 50% of subjects were postmenopausal.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EInvestigators concluded that midlife patients who are treated for major depression have many lifestyle, iatrogenic, and historical risk factors that raise the likelihood of poor bone quality and osteoporotic fractures at younger ages.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003E\u201cWe believe that lifestyle interventions are appropriate for this population, including calcium and vitamin D supplementation and enhanced weight-bearing physical activity. In addition, coordinated primary care follow-up should be a priority, and heavy smokers and alcohol abusers should receive substance abuse treatment,\u201d concluded Dr. Gracious.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/4\/14.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmsc1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}