Bone Status in Obese, Non-diabetic, Antipsychotic-Treated Patients, and Effects of the Glucagon-Like Peptide-1 Receptor Agonist Exenatide on Bone Turnover Markers and Bone Mineral Density

Background: Low bone mineral density (BMD) may constitute an underestimated comorbidity in schizophrenia patients undergoing long-term antipsychotic treatment. Glucagon-like peptide 1 (GLP-1) receptor agonists are antidiabetic drugs, which may also affect bone turnover. Methods: In planned secondary analyses of a 3 months, double-blind, randomized, placebo-controlled trial ( n = 45), we explored effects of the GLP-1 receptor agonist exenatide 2 mg once-weekly ( n = 23), or placebo ( n = 22) on bone turnover markers (BTMs) and BMD in chronic, obese, antipsychotic-treated patients with schizophrenia spectrum disorder. Baseline BTMs were compared to sex- and age-adjusted reference values from a Danish population cohort, and T- and Z- scores were calculated for BMD. Results: In women ( n = 24), all baseline BTM measurements of procollagen type I N-terminal propeptide (PINP) and C-terminal cross-linking telopeptide of type I collagen (CTX) were within reference values. In men ( n = 21), 5% displayed lower PINP and 14% displayed lower CTX. One patient displayed BMD Z- score T- scores P = 0.05), and body mass index BMD increased for L2-L4 ( P = 0.016). No changes in bone markers were significant after correction for mean prolactin levels. Conclusions: Sex- and age-adjusted measures of bone status in chronic, obese, antipsychotic-treated patients appeared comparable to the reference population. Subtle changes in bone markers during 3 months exenatide treatment may suggest beneficial effects of GLP-1 receptor agonists on bone status in antipsychotic-treated patients, and further studies should consider the potential influence of prolactin

Agonist · Antipsychotic · Bone density · Bone mineral · Bone remodeling · Diabetes mellitus · Exenatide · Glucagon-like peptide 1 receptor · Glucagon-like peptide-1 · Osteoporosis · Psychiatry · Receptor · Schizophrenia (object-oriented programming · Sclerostin · Signal transduction · Type 2 diabetes · Chemistry · Diabetes Treatment and Management · Diet and metabolism studies · Medicine · Metabolism, Diabetes, and Cancer · Biochemistry · Endocrinology · Internal Medicine

• Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia

  Stefan Leucht, Andrea Cipriani et al.•The Lancet•2013

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