Osteoporosis after combined use of a neuroleptic and antidepressants.

UNLABELLED: Bone mineral density may be negatively influenced by hyperprolactinemia, which can be caused by atypic neuroleptics and antidepressants. CASE DESCRIPTION: The present paper reports about a spontaneous rib fracture in a female patient (age 52) taking neuroleptics (mainly risperidone), antidepressants (mainly sertraline), and anxiolytics (mainly lorazepam). At the time of the fracture a severe osteoporosis and a strongly enhanced plasma prolactin level (117 ng/ml; normal values: 3-24 ng/ml) were detected. The latter one normalized 2 months after abandoning sertraline and risperidone. After this normalization, the patient did not report further accidents up to now. DISCUSSION: Enhancement of plasma prolactin levels is linked to the mechanism of action of risperidone. Mammoplasia and increased plasma prolactin can occur during SSRI (Selective Serotonin Reuptake Inhibitors) or trazodone administration. The role of anxiolytics is less clear. The causal relationship between osteoporosis and long-term use of neuroleptics and antidepressants was assessed using probability scores, more particularly the Naranjo probability scale and the Bradford-Hill criteria of causality. A score of 6/13 (probable) was obtained with the Naranjo scale, whereas all 9 Bradford-Hill criteria were fulfilled. CONCLUSION: Although this case could not be fully explored, attention should be paid to bone mineral density loss in depressed patients taking a combined therapy of atypic antipsychotics and antidepressants.

Fraturas costais espontâneas em asmáticos tomadores crônicos de corticóides / Spontaneous rib fractures in asthmatic patients with long intake of corticosteroids

Tryes pacientes asmáticos tomadores crônicos de corticóides (ATCC) com fraturas costais sintomáticas e espontâneas e um com fratura costal assintimática foram comparados a 50 ATCC que näo apresentavam fraturas. Os dois grupos näo diferiam em relaçäo à média de idade (53,5 ñ 4,0 x 48,0 ñ 1,04), duraçäo da asma (12,5 ñ 5,8 x 19,5 ñ 12,7), tempo de uso de corticóide (5,0 ñ 3,5 x 4,5 ñ 2,4) e dose média de prednisona no último ano (20,0 ñ 0,0 x 18,3 ñ 7,15). As mulheres predominaram no grupo controle 35 em 50), enquanto havia três homens entre os quatro pacientes com fraturas costais. As fraturas foram múltiplas em três pacientes e única em um. As fraturas costais à direita predominaram (16 x 9); os arcos posteriores e laterais foram igualmente comprometidos. Em um paciente foram observadas pontes interósseas exuberantes, e a consolidaçäo das fraturas foi normal. Os três pacientes com fraturas sintomáticas foram tratados com calcitonina, vitamina D e fluoreto de cálcio, mas näo foi possível avaliar a eficácia do tratamento devido a sua curta duraçäo (três meses)

[Iatrogenic aluminum osteopathy in a uremic infant]. / Iatrogene Aluminiumosteopathie bei einem urämischen Säugling.

An infant with uremia due to congenital renal hypoplasia was treated with oral aluminum hydroxide for 9 months in an attempt to reduce hyperphosphatemia. An increasingly painful osteopathy with pathological fractures ensued with loss of thoracic wall stability and respiratory failure. Increased serum aluminium levels and histochemically proved deposits of aluminium at the mineralisation front between calcified and noncalcified osteoid were demonstrated. In the context of recent findings concerning aluminium bone toxicity it is beyond doubt that this phosphate binding agent was detrimental for this child. Though a low phosphate diet normalized hyperphosphatemia after aluminium hydroxide treatment had been stopped, no effect on the progressive osteopathy was observed. Since aluminium hydroxide as a phosphate binder can be replaced by calcium carbonate or a low phosphate diet at least in young children, it should not be further recommended in this age group. This seems especially important in nondialyzed patients.