Antipsychotics and osteoporosis: current awareness and practice in primary care

As part of health surveillance in mental illness, GPs are increasingly being asked to check prolactin on those taking antipsychotics. Risperidone, amisulpride, and older antipsychotics raise prolactin and this in turn is a cause of osteoporosis.¹,² The level of awareness and current practice of antipsychotic-induced hyperprolactinaemia in primary care is unknown.

To find answers 28 GP practices were surveyed. In the first survey (13 practices, 59 GPs) we asked, ‘Are you aware of any guidelines around the management of hyperprolactinaemia? ’ Nineteen (32%) responded and all said no. Most would seek specialist advice and were unaware of its management. In the second survey (15 practices, 54 GPs) we asked, ‘Have you been aware of any associations between hyperprolactinaemia and osteoporosis? ’ Fifteen (28%) responded and three (20%) were aware.

Neither the National Institute for Health and Care Excellence nor the Royal College of Psychiatrists have published guidelines. There are very few local guidelines but the Maudsley recommendations are widely recognised within secondary care.³,⁴ High prolactin is a known cause of premature osteoporosis and high prolactin is common on antipsychotics. Men are probably at risk as much as women are since prolactin is an independent factor.⁵ These health risks are clearly important but there is confusion as to who should oversee its surveillance and management. With the ever-increasing demands on primary care there is a view that management of high prolactin from antipsychotics falls outside their remit. Local or national guidelines would at least make it less threatening. As it stands, prolactin monitoring has been done in primary care when asked but its management is seen as a secondary care responsibility. All parties should cooperate to address this gap in health care since a significant proportion of young people with mental illness will generate health and financial burdens of premature osteoporosis.

• © British Journal of General Practice 2014