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Serum Prolactin and Bone Mineral Density in Women with Schizophrenia Receiving Prolactin-Raising Antipsychotics: A Cross-Sectional Study

Year: 2026

Type: article

Abstract: Background/Objectives: Antipsychotic-induced hyperprolactinemia may adversely affect skeletal health through suppression of the hypothalamic–pituitary–gonadal axis; however, the independent association between circulating prolactin and bone mineral density (BMD) remains uncertain. Methods: This cross-sectional study examined the association between serum prolactin concentration and BMD Z-scores among women with schizophrenia receiving prolactin-raising antipsychotics. Sixty-eight women underwent serum prolactin measurement and dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total hip. Because prolactin concentrations were right-skewed, natural-log-transformed prolactin was used in linear regression analyses. Multivariable models adjusted for age, body mass index (BMI), duration of prolactin-raising antipsychotic exposure, chlorpromazine-equivalent dose, and physical activity, with heteroskedasticity-robust standard errors. Results: Median serum prolactin concentration was 44.51 ng/mL (IQR 16.36–78.37). Serum prolactin was not independently associated with BMD Z-score at the lumbar spine (adjusted β = 0.196, 95% CI −0.212 to 0.605; p = 0.340), femoral neck (β = 0.157, 95% CI −0.142 to 0.456; p = 0.298), or total hip (β = −0.224, 95% CI −0.587 to 0.139; p = 0.221). Higher BMI was positively associated with femoral neck and total hip Z-scores, while physical activity was positively associated with BMD Z-scores at all three sites. In a sensitivity analysis restricted to risperidone-treated participants (n = 60), serum prolactin remained unassociated with BMD Z-scores at all sites. Conclusions: In this cohort, contemporaneous serum prolactin concentration was not independently associated with BMD Z-scores. These findings support a multifactorial approach to skeletal health and warrant confirmation in larger longitudinal studies incorporating cumulative prolactin exposure and endocrine and bone-turnover markers.

Source: Pharmacoepidemiology

DOI: 10.3390/pharma5030031

Authors: Kamonrat Somrak, Chompoonuch Werawattanachai, Apiradee Sangngarm, Sipanut Silaket, Tuanthon Boonlue

Institutions: Prasrimahabhodi Psychiatric Hospital, Ratchathani University, Ubon Ratchathani University

Language: English

Topic: Schizophrenia research and treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,207