Selective Serotonin Reuptake Inhibitors (SSRIs) and Markers of Bone Turnover in Men
Selective serotonin reuptake inhibitors (SSRIs) have been shown to have a clinically significant impact on bone metabolism. To explore this further, we aimed to determine whether these agents are associated with serum markers of bone turnover utilising a population-based sample of men (n = 1138; 20–96 year) participating in the Geelong Osteoporosis Study. Blood samples were obtained and the bone resorption marker, C-telopeptide (CTx) and formation marker, type 1 procollagen amino-terminal-propeptide (PINP) were measured. Anthropometry and socio-economic status (SES) were determined and information on medication use and lifestyle was obtained via questionnaire. Lifetime mood disorders were assessed using semi-structured clinical interviews. Thirty-seven (3.3%) men reported using SSRIs. Age was an effect modifier in the association between SSRIs and markers of bone turnover. Among younger men (20–60 year; n = 557), adjusted mean CTx and PINP values were 12.4% [16.7 (95% CI 14.6–18.8) vs 19.1 (95% CI 18.7–19.4) pg/ml, p = 0.03] and 13.6% [5.6 (95% CI 4.9–6.3) vs 6.4 (95% CI 6.3–6.6) pg/ml, p = 0.02] lower among SSRI users compared to non-users, respectively. No differences in SSRI use and markers of bone turnover were detected among older men (61–94 year; all p > 0.05). These patterns persisted after further adjustment for activity, alcohol, smoking, SES, depression, bone active medications and other antidepressants. Our data suggest that SSRI use is associated with alterations in bone turnover markers among younger men. The observed decreases in both CTx and PINP are likely to contribute to a low bone turnover state and increased skeletal fragility with this potential imbalance between formation and resorption resulting in subsequent bone loss.
KeywordsAntidepressants Bone turnover Bone metabolism Osteoporosis Depression Psychiatry
This work was supported by the National Health and Medical Research Council (NHMRC), Australia (Projects 299831, 628582, 1009367, 1026265, 1021345, 1104438). LJW is supported by a NHMRC Career Development Fellowship (1064272). MB is supported by a NHMRC Senior Principal Research Fellowship (1059660). VC and JC are supported by Postgraduate Scholarships from Deakin University. The funding providers played no role in the design or conduct of the study; collection, management, analysis and interpretation of the data; or in preparation, review or approval of the manuscript.
Compliance with Ethical Standards
Conflict of interest
LJW has received grant/research support from Eli Lilly, Pfizer, The University of Melbourne, Deakin University. MB has received Grant/Research Support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF, NHMRC, Beyond Blue, Rotary Health, Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Meat and Livestock Board, Organon, Novartis, Mayne Pharma, Servier and Woolworths, has been a speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth, and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck Merck, Pfizer and Servier. JAP has recently received grant/research support from the National Health and Medical Research Council (NHMRC), BUPA Foundation, Amgen/GlaxoSmithKline/Osteoporosis Australia/Australian and New Zealand Bone and Mineral Society, Western Alliance, Barwon Health, Deakin University and the Geelong Community Foundation. JH, MAK, ALS, VC and JC have no disclosures.
The Human Research Ethics Committee at Barwon Health approved the study.
Human and Animal Rights and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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