Proceedings of the 6th Annual GRASP Symposium, Wichita State University, 2010
Bone Mineral Density and Body Composition Assessment In
Individuals with Severe Mental Illness
Ashley M. Hervey*, Ashley R. Fryman
Faculty: Jeremy Patterson
Department of Human Performance Studies
Abstract.Bone Density among the average population has been researched however little has been reported on the
effects of Severe Mental Illness (SMI) on bone density (BMD). BMD of the forearm, femoral neck and body % was
measured by a DXA unit (Hologic QDR 4500). 30 individuals (17 male; 13 female) with SMI (bipolar (N=14),
schizophrenia (N=5), schizoaffective (N=4), major depression/depression (N=2), and other (N=5)) volunteered for
the study. Total group (N=30) body fat % (37.3±8.4) and BMI (32.4±6.06) is significantly greater than national and
state averages. Bipolar (N=14) showed the highest body fat % (39.1±8.1 vs. 30.7±9.4 %, p<0.05.
Introduction
Bone is a living, dynamic tissue that is the single most important supportive tissue in the human body [1]. Bone
strength is determined by bone mineral density (BMD) which accounts for up to 70% of total bone strength [2].
Psychiatric disorders are associated with an increased rate of premature death [3]. While a number of recent reports
have investigated the risk of obesity and metabolic syndrome in patients with Severe Mental Illness, few studies
have investigated other potential serious long-term side-effects such as osteopenia or osteoporosis [4,5,6]. This study
was to determine the bone mineral density (BMD) and body composition (Body Fat %) of individuals with severe
mental illness.
2. Experiment, Results, Discussion, and Significance
Methods: Thirty individuals (aged 21-66) with severe mental illness 30 individuals (17 male; 13 female) with SMI
(bipolar (N=14), schizophrenia (N=5), schizoaffective (N=4), major depression/depression (N=2), and other (N=5))
volunteered for the study. The participants were recruited from Breakthrough (Wichita, Kansas) and all conditions
were stable (no change in medication regime for three weeks prior to enrollment). The study was approved by the
Institutional Review Board. Written informed consent was obtained from each subject prior to testing. Height and
weight were obtained in the Human Performance Laboratory (Wichita State University), prior to the BMD scan.
Bone mineral Density and Body composition were measured by a dual energy x-ray absorptiometry (DXA) unit
(Hologic QDR 4500). Standard protocol set forth by the manufacturer, for the non-dominant forearm, femoral neck,
and whole body scans were followed.
Results: This study was designed to measure the bone mineral density and body composition of individuals with
severe mental illness, using the DEXA. Total group (N=30) body fat % (37.3±8.4) and BMI (32.4±6.06) is
significantly greater than national and state averages. By groups, bipolar (N=14) showed the highest body fat %
(39.1±8.1 vs. 30.7±9.4 %, p<0.05), forearm and femoral neck t-scores were normal. Schizophrenia group (N=5),
schizoaffective (N=4), major depression/depression (N=2), and other (N=5), body fat %, forearm t-score,
femoral neck t-score were within normal range (results found in Table 1). Of the individuals with bipolar
disorder 57% are currently taking one of the four drugs (Zyprexa, Abilify, Risperdol, Seroquel) found to cause
excess weight gain in children and adolescents [7]. Those individuals with the diagnosis of schizophrenia were
found to have the lowest t-scores in both their femoral necks and forearms.
Discussion: These participants have several risk factors other than medications to cause lower BMD and high BF%.
Many of the individuals that were tested live lifestyles that can cause lower BMD and higher BF%. These can
include but aren’t limited to smoking, excessive carbonated soft drink consumption, consumption of alcohol, and
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Proceedings of the 6th Annual GRASP Symposium, Wichita State University, 2010
poor diets. . This study has found the same outcome of other studies [8,9], that antipsychotic drug treatment may
cause long-term consequences that include bone loss.
Table 1: Results
Whole Body
t-score
Body Fat %
Forearm
t-score
Femoral Neck
t-score
Bipolar Disorder (N= 14)
Schizophrenia (N=5)
39.1±8.1
26.38±8.0
-0.1±1.0
-0.6±1.43
-0.1±0.8
-1.0±1.08
Schizoaffective (N=4)
Major Depression (N=2)
Other (N=5)
27.33±3.8
32.8±8.13
34.7±8.33
-0.4±1.56
0.8±0.42
-0.7±0.91
0.4+0.51
-0.4±0.42
-0.9±0.70
37.3±8.4
-0.3±1.1
-0.4±0.8
Total Group
32.4±6.06
Significance: The information gained in this study will be particularly beneficial to exercise professionals, medical
professionals, and the participants. This is an original study that has an outcome that would be both beneficial to the
general public and have a significant contribution to the scientific field. The data collected provided information that
is relevant to the understanding of mental illness, the medication to control the illness, and the changes in bone
density.
3. Conclusions
This pilot study adds to the limited evidence about the underserved population of severe mental illness, with results
showing a decreased bone mineral density and increased body fat %. Many studies that are present are on
psychiatric inpatients or on hospitalized patients. This study shows results for individuals who are living within the
community with their illness. Additional research is needed to support these finding.
4. Acknowledgements
I would like to thank Breakthrough for allowing me to help their members through this study. Thank you, Ashley
Fryman for the many hours that you helped me with the DXA. It made the scans go much faster and the time more
manageable. I would like to thank Dr. Jeremy Patterson for allowing me to work on this project. I enjoyed it and
learned so much, even though it didn’t always seem that way. And finally, thank you WSU for awarding us the
ULINK grant last year, which allowed this project to happen.
5. References
[1] Prentice, A. (1997). Is nutrition important in osteoporosis? Proceedings of the Nutrition Society, 56, 357-367
[2] Allison, D. & Casey, D. (2001). Antipsychotic induced weight gain: a review of the literature. Journal of Clinical Psychiatry, 62, 22-31.
[3] Barraclough, E., & Harris, B. (1998). Excess mortality of mental disorder. British Journal of Psychiatry, 11-53
[4] Hollahan, B., Lyons, D., & Doyle, P. (2008). Bone mineral density and general health of long-term residential psychiatric inpatients.
Irish Journal of Psychological Medicine, 25(3).
[5] O’Brien, S., Devitt, E., Ahmed, M., & McDonald, C. (2007). High prevalence of risk factors for physical illness in a long-stay psychiatric
unit. Irish Journal of Psychological Medicine, 24, 55-58.
[6] Tirupati, S., & Chua, L. (2007). Obesity and metabolic syndrome in a psychiatric rehabilitation service. Australian and New Zealand
Journal of Psychiatry, 47(7), 606-610.
[7] Varley, C., & McClellan, J. (2009). Implications of marked weight gain associated with atypical antipsychotic medications in children and
adolescents. Journal of the American Medical Association, 302(16), 1811-1812.
[8] Haddad, P., & Wieck, A. (2004). Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management. Drugs,
64(20), 2291-2314.
[9] Meaney, A., Smith, S., Howes, O., O’Brien, M., Murray, R., & O’Keane, V. (2004). Effects of longer-term prolactin-raising antipsychotic
medications on bone mineral density, in patients with schizophrenia. British Journal of Psychiatry, 184, 503-508.
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