A study in JAMA Psychiatry reveals another potential benefit of lithium treatment. Bipolar patients in general have a significantly higher rate of osteoporosis than the general population, for reasons that are not clear, but could have to do with treatment with antipsychotic medications, a higher rate of alcohol use and a higher rate of tobacco consumption. Thus it is noteworthy that this study shows that lithium protects against osteoporosis.
In fact, lithium is the only treatment with a clear, dose dependent, protective effect.
The authors note that there is evidence to suggest that lithium’s effects are mediated by the stimulation of bone formation through activation of β-catenin via inhibition of glycogen synthase kinase-3β. This effect has led to an ongoing study of lithium as a potential treatment designed to improve the outcomes of bone fractures (see Nam, et al below).
There are a number of other studies derived from the same large database of all the individuals ever treated for a psychiatric disorder since 1970 in Denmark.
Köhler-Forsberg O, Rohde C, Nierenberg AA, Østergaard SD. Association of Lithium Treatment With the Risk of Osteoporosis in Patients With Bipolar Disorder. JAMA Psychiatry. Published online March 30, 2022. doi:10.1001/jamapsychiatry.2022.0337
Nam D, Balasuberamaniam P, Milner K, et al. Lithium for Fracture Treatment (LiFT): a double-blind randomised control trial protocol. BMJ Open. 2020;10(1):e031545. doi:10.1136/bmjopen-2019-031545
Mors O, Perto GP, Mortensen PB. The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health. 2011;39(7_suppl):54-57. doi:10.1177/1403494810395825