Abstract
Many central nervous system active drugs can alter postural balance, increasing the risk of fractures. Anxiolytics and sedatives include the benzodiazepines, and these have been associated with a limited increase in the risk of fractures, even at low doses, probably from an increased risk of falls. No systematic differences have been shown between benzodiazepines with long and short half-lives. Although the increase in risk of fractures was limited, care must still be taken when prescribing for older fall-prone subjects at risk of osteoporosis. Neuroleptics may be associated with a decrease in bone mineral density and a very limited increase in fracture risk. Antidepressants are associated with a dosedependent increase in the risk of fractures. The increase in relative risk of fractures seems to be larger with selective serotonin reuptake inhibitors (SSRIs) than with tricyclic antidepressants. The reason for this is not known but may be linked to serotonin effects on bone cells and the risk of falls. With the wide use of SSRIs, more research is needed. Lithium is associated with a decrease in the risk of fractures. This may be linked to its effects on the Wnt glycoprotein family, which is a specialised signalling system for certain cell types.
Keywords: Central Nervous System Active Drugs, Anxiolytics, Sedatives, Antidepressants, Lithium and Neuroleptics, benzodiazepines, osteoporosis, serotonin
Current Drug Safety
Title: Skeletal Effects of Central Nervous System Active Drugs: Anxiolytics, Sedatives, Antidepressants, Lithium and Neuroleptics
Volume: 3 Issue: 3
Author(s): Peter Vestergaard
Affiliation:
Keywords: Central Nervous System Active Drugs, Anxiolytics, Sedatives, Antidepressants, Lithium and Neuroleptics, benzodiazepines, osteoporosis, serotonin
Abstract: Many central nervous system active drugs can alter postural balance, increasing the risk of fractures. Anxiolytics and sedatives include the benzodiazepines, and these have been associated with a limited increase in the risk of fractures, even at low doses, probably from an increased risk of falls. No systematic differences have been shown between benzodiazepines with long and short half-lives. Although the increase in risk of fractures was limited, care must still be taken when prescribing for older fall-prone subjects at risk of osteoporosis. Neuroleptics may be associated with a decrease in bone mineral density and a very limited increase in fracture risk. Antidepressants are associated with a dosedependent increase in the risk of fractures. The increase in relative risk of fractures seems to be larger with selective serotonin reuptake inhibitors (SSRIs) than with tricyclic antidepressants. The reason for this is not known but may be linked to serotonin effects on bone cells and the risk of falls. With the wide use of SSRIs, more research is needed. Lithium is associated with a decrease in the risk of fractures. This may be linked to its effects on the Wnt glycoprotein family, which is a specialised signalling system for certain cell types.
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Cite this article as:
Vestergaard Peter, Skeletal Effects of Central Nervous System Active Drugs: Anxiolytics, Sedatives, Antidepressants, Lithium and Neuroleptics, Current Drug Safety 2008; 3 (3) . https://dx.doi.org/10.2174/157488608785699432
DOI https://dx.doi.org/10.2174/157488608785699432 |
Print ISSN 1574-8863 |
Publisher Name Bentham Science Publisher |
Online ISSN 2212-3911 |
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