Pituitary. 2020 Mar 26. doi: 10.1007/s11102-020-01041-3. [Epub ahead of print]
Prolactin (PRL) has direct and indirect effects on bone metabolism. Experimental studies showed that in the presence of high PRL levels bone resorption was increased as well as bone formation was suppressed. Increased PRL levels in humans caused a reduction in sex hormone levels which turn may have detrimental effects on bone. Patients with hyperprolactinemia did have often decreased bone mineral density as well as an increased risk of fractures. Since PRL control may be relevant to bone health it is a clinical open issue the inclusion of skeletal health in future guidelines as indication to proactive screening, prevention and treatment particularly in high risk patients such as hyperprolactinemic women after menopause and patients with drug induced hyperprolactinemia.
In conclusion, hyperprolactinemia has a relevant clinical impact on bone metabolism determining low BMD and increased risk of fractures. The pathogenesis of hyperprolactinemia– induced bone loss is multifactorial, because both direct and indirect (hypogonadism) skeletal effects may be involved. Treatment with dopamine agonists seem to be protective against VFs in male and female patients with prolactinoma and effective in controlling PRL levels in patients with antipsychotic induced hyperprolactinemia. Bone status and risk of fracture should be incorporated in future guidelines on hyperprolactinemia since at specific risk categories such as post-menopausal women with prolactinoma and patients under antipsychotic drugs should be granted adequate proactive screening, prevention and treatment of the bone complications of hyperprolactinemia.