Table 3. Bone mineral density/bone turnover marker in schizophrenia compared with healthy control (reference data after 2005).
| Study | Country | Patient inclusion criteria | Patient (n) | Healthy control | Control (n) |
Mean age |
Male % | BMD measurement |
Results |
|---|---|---|---|---|---|---|---|---|---|
| Study using control group: N=11 | |||||||||
| Sugawara et al., 2012 [31■] |
Japan | Diagnosed as SCZ or SCZAD at 3 psychiatric hospitals in northern Japanese region |
362 | Healthy population from same region |
832 | 54.7 | 42.3 | QUS | Male OSI |
| 20–49 yo: SCZ=HC | |||||||||
| ≥50 yo: HC>SCZ (P<0.05) |
|||||||||
| Female OSI | |||||||||
| 20–59 yo: SCZ=HC | |||||||||
| ≥60 yo: HC>SCZ (P<0.05) |
|||||||||
| Jung et al., 2011 [32] |
South Korea | Inpatients with schizophrenia aged ≥50 yo |
229 | No medical and psychiatric illness aged ≥50 yo |
125 | 58.6 | 43.2 | DEXA | Osteoporosis prevalence: SCZ>HC (P=0.0043) |
| FN: HC>SCZ (P<0.005) |
|||||||||
| FW: HC>SCZ (P<0.05) |
|||||||||
| Trochanter: HC>SCZ (P<0.005) |
|||||||||
| Doknic et al., 2011 [33] |
Serbia | Stable outpatients in real-life conditions without psychiatric comorbidity |
26 | Sex, age, BMI, and education matched |
35 | 31.8 | 37.8 | DEXA | LS: SCZ=HC |
| FN: SCZ=HC | |||||||||
| OC: SCZ=HC | |||||||||
| CTX: SCZ>HC (P=0.023) |
|||||||||
| Partti et al., 2010 [34] |
Finland | Population-based sample with primary psychotic disorder |
48 | Population-based sample |
6241 | 52.0 | 50.0 | QUS | BUA: population sample >SCZ (P<0.001) |
| SoS: population sample >SCZ (P<0.001) |
|||||||||
| Renn et al., 2009 [35] |
Taiwan | Chronic schizophrenia aged ≥20 yo |
965 | Community population living in the same district aged ≥20 yo |
405 | 50.2 | 59 | QUS | BUA: HC>SCZ (P<0.01) |
| Rey-Sánchez et al., 2009 [36] |
Spain | Under treatment on antipsychotics ≥5 years |
73 | Age, weight, height, and gonadal status matched |
73 | 61.0 | 66 | QUS | Female |
| SoS: HC>SCZ (P<0.05) | |||||||||
| TRAP: SCZ>HC (P<0.0001) |
|||||||||
| Male | |||||||||
| SoS: SCZ>HC (P<0.05) |
|||||||||
| TRAP: SCZ=HC | |||||||||
| Bergemann et al., 2008 [37] |
Germany | Premenopausal female schizophrenia (59 received BMD measurement) |
72 | Age, sex-matched healthy control |
71 | 33.8 | 0 | DEXA | FN: SCZ=HC |
| LS: SCZ=HC | |||||||||
| PYD: SCZ>HC (P<0.001) |
|||||||||
| DPD: SCZ>HC (P=0.001) |
|||||||||
| OC: SCZ>HC (P<0.001) |
|||||||||
| Jung et al., 2006 [38] |
South Korea | Inpatient who had taken haloperidol monotherapy for ≥2 years |
51 | Similar age | 57 | 39.0 | 59.2 | DEXA | LS: HC>SCZ (P<0.05) |
| FN: HC>SCZ (P<0.005) | |||||||||
| FW: HC>SCZ (P<0.005) | |||||||||
| Trochanter: HC>SCZ (P<0.005) |
|||||||||
| Bilici et al., 2002 [39] |
Turkey | Patients on classical or atypical antipsychotics for average of 14 months |
75 | No significant difference in age and sex |
20 | 29.9 | 50.1 | DEXA | L1: HC=atypical >classical |
| L2: HC=atypical >classical |
|||||||||
| L3: HC=atypical >classical |
|||||||||
| L4: HC=atypical >classical |
|||||||||
| Keely et al., 1997 [40] |
Canada | Male patients who had taken neuroleptic medication for 1–30 years |
16 | Age, sex matched | 16 | 41.0 | 100 | DEXA | LS: HC>SCZ |
| Trochanter: HC>SCZ | |||||||||
| Ward’s triangle: HC>SCZ |
|||||||||
| FN: SCA=HC | |||||||||
| Baastrup et al., 1980 [6] |
Denmark | Patients treated with antipsychotics, whose serum creatinine is ≤13mg/l |
50 | People with a normal creatinine value, and having no digestive or renal diseases |
252 | 39.8 | 52.0 | Photon-absorptio- metry |
BMC: HC>SCZ (86% of normal value; P<0.001) |
| Subtotal N=11 | 1967 | 8127 | 51.3 | 49.8 | BMD lower in SCZ at least in one region, or in one subgroup: positive=10/11 |
||||
| BTM abnormality in SCZ at least in one marker, or in one subgroup: positive=3/3 |
|||||||||
| Studies using reference data: N=5 |
|||||||||
| Kishimoto et al., 2008 [41] |
Japan | Male inpatients with schizophrenia |
74 | Age, sex-matched reference data |
NA | 58.9 | 100 | DEXA | BMD: |
| 30–39 yo: SCZ=HC | |||||||||
| 40–49 yo: HC >SCZ (P<0.05) |
|||||||||
| 50–54 yo: SCZ=HC | |||||||||
| 50–79 yo: HC >SCZ (P<0.05) |
|||||||||
| Howes et al., 2005 [42] |
UK | Consecutive outpatient clinic attendees |
102 | Reference value of the same age, sex, and ethnicity |
NA | 46.0 | 47 | DEXA | Female |
| LS, FN, hip: SCZ=HC | |||||||||
| OC, DPD: normal range | |||||||||
| Male | |||||||||
| LS: HC>SCZ in black men |
|||||||||
| FN, hip: SCZ=HC | |||||||||
| OC: exceeded upper limit | |||||||||
| DPD: normal range | |||||||||
| Hummer et al., 2005 [43] |
Austria | In and outpatients with SCZ treated with antipsychotics ≥1 year |
75 | Age, sex-matched reference data |
NA | 34.8 | 76.0 | DEXA | Male BMD: HC >SCZ (P<0.001) |
| Female BMD: SCZ=HC | |||||||||
| Kishimoto et al., 2005 [44] |
Japan | Inpatients with SCZ or SCZAD | 133 | Age, sex-matched reference data |
NA | 55.4 | 0 | QUS | Stiffness: |
| 20–24, 35–44, >55 yo: HC>SCZ (P<0.01) |
|||||||||
| 25–29, 50–54 yo: HC>SCZ (P<0.05) |
|||||||||
| 30–34, 45–49 yo: HC=SCZ |
|||||||||
| Halbreich et al., 1995 [7] |
USA | Acutely ill psychiatric patients admitted to psychiatric ward |
68 (40 SCZ or SCZAD, 28 with other Dx) |
National standard reference data (which was found to be equivalent to local healthy people) |
NA | 39.4 | 51.5 | DPA | Male |
| LS: HC>SCZ (P=0.0001) |
|||||||||
| FN: HC>SCZ (P<0.0001) | |||||||||
| Female | |||||||||
| LS: HC>SCZ (P<0.0001) | |||||||||
| FN: SCZ=HC | |||||||||
| Subtotal N=5 | 452 | NA | 48.0 | 47.3 | BMD lower in SCZ at least in one region, or in one subgroup: positive=5/5 |
||||
| BTM abnormality in SCZ at least in one marker, or in one subgroup: positive=1/1 |
|||||||||
| ITotal N=16 | Patient total n=2419 |
Control total n=8127 |
51.2 | 49.7 | BMD lower in SCZ at least in one region, or in one subgroup: positive=15/16 |
||||
| BTM abnormality in SCZ at least in one marker, or in one subgroup: positive=4/4 |
|||||||||
BMC, bone mineral content; BMD, bone mineral density; BTM, bone turnover marker; BUA, broadband ultrasound attenuation; DPA, dual-photon absorptiometry; Dx, diagnosis; FN, femoral neck; FW, femoral Ward’s triangle; LS, lumbar spine; NA, not applicable; OSI, osteosono-assessment index; PYD, pyridinoline; SCZ, schizophrenia; SCZAD, schizoaffective disorder; SoS, speed of sound; yo, years old.