Osteoporosis International

, Volume 29, Issue 6, pp 1243–1251 | Cite as

Effect of selective serotonin reuptake inhibitors on bone mineral density: a systematic review and meta-analysis

  • C. Zhou
  • L. Fang
  • Y. Chen
  • J. Zhong
  • H. Wang
  • P. Xie


Our work is the first systematic meta-analysis to investigate the effect of selective serotonin reuptake inhibitor (SSRI) medication on bone mineral density. Through meta-analyzed 11 studies, our findings suggested that compared with nonusers, use of SSRIs was significantly associated with lumbar spine BMD reduction, particularly for old people. The use of selective serotonin reuptake inhibitors (SSRIs) has already been associated with bone mass loss. Their effects on bone mineral density (BMD) for the different bone sections have, however, thus been inconsistent. Here, we aim to assess the effects of SSRIs on BMD using a meta-analysis. We searched PubMed, Scopus, ISI Web of Knowledge, the Cochrane Library, and PsycINFO for all English-written studies investigating the effects of SSRIs on BMD and published before November 2017. BMD was compared between non-SSRI users and SSRI users using a random-effect model with standardized mean differences (SMD) and 95% confidence intervals (CIs). Furthermore, subgroup analyses were performed based on study design, age, and sex in order to find the origins of high heterogeneity. Eleven studies met the inclusion criteria and were used for the meta-analysis. Our study demonstrated that the use of SSRIs was significantly associated with lower BMD values (SMD − 0.40; 95% CI − 0.79 to 0.00; p = 0.05) and BMD Z-scores (SMD − 0.28; 95% CI − 0.50 to − 0.05; p = 0.02) of the lumbar spine, but not of the total hip and femoral neck. In addition, SSRI use was associated with a greater bone loss in older people. SSRI use is a risk factor of lower BMD of the lumbar spine, especially for older people. Future studies into the relationship between SSRI use and bone metabolism and bone mass need to be conducted with larger sample sizes for both men and women at different bone sites.


Antidepressant Bone mineral density Meta-analysis Selective serotonin reuptake inhibitors 



The work was supported by The National Key Research and Development Program of China (Grant No. 2017YFA0505700), National Natural Science Foundation of China (Grant No. 81701361), and China Postdoctoral Science Foundation funded project (Project No. 2017M612924).

Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2018_4413_MOESM1_ESM.doc (63 kb)
Table S1 PRISMA 2009 checklist (DOC 63 kb).
198_2018_4413_MOESM2_ESM.xlsx (12 kb)
Table S2 BMD value, BMD T-score and BMD Z-score of 11 included studies (XLSX 12 kb).


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • C. Zhou
    • 1
    • 2
    • 3
  • L. Fang
    • 1
  • Y. Chen
    • 1
  • J. Zhong
    • 1
  • H. Wang
    • 2
    • 3
  • P. Xie
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of NeurologyYongchuan Hospital of Chongqing Medical UniversityChongqingChina
  2. 2.Institute of NeuroscienceChongqing Medical UniversityChongqingChina
  3. 3.Chongqing Key Laboratory of NeurobiologyChongqing Medical UniversityChongqingChina
  4. 4.Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina

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