Abstract
Depression is one of the most important mental health problems and a leading cause of disability. Selective serotonin reuptake inhibitors (SSRIs) are considered as first-line therapy for the treatment of depressive symptoms among older adults because of their presumed favorable adverse effect profile. However, they could have deleterious effects on the bone. Evidence from longitudinal, cross-sectional, and prospective cohort studies suggests that the use of antidepressants at therapeutic doses is associated with decreased bone mineral density and increased fracture risk. The association between SSRIs use and fracture risk could potentially differ depending on dose, exposure duration, time of exposure, age, or sex. However, the risk of fracture declined rapidly after discontinuation of use of SSRIs. The evidence now seems sufficient to consider adding SSRIs to the list of medications that contribute to osteoporosis. In practice, assessment of risk factor for osteoporosis or fractures could be made taking into account age, gender, duration, and severity of depression, length of SSRI treatments, and other concurrent risk factors.
This is a preview of subscription content, access via your institution.
References
E.S. Paykel, Depression: major problem for public health. Epidemiol. Psichiatr. Soc. 15(1), 4–10 (2006)
R.S. Shim, P. Baltrus, J. Ye, G. Rust, Prevalence, treatment, and control of depressive symptoms in the United States: results from the National Health and Nutrition Examination Survey (NHANES), 2005–2008. J. Am. Board Fam. Med. 24(1), 33–38 (2011). doi:10.3122/jabfm.2011.01.100121
J. Alonso, M.C. Angermeyer, S. Bernert, R. Bruffaerts, T.S. Brugha, H. Bryson, G. de Girolamo, R. Graaf, K. Demyttenaere, I. Gasquet, J.M. Haro, S.J. Katz, R.C. Kessler, V. Kovess, J.P. Lepine, J. Ormel, G. Polidori, L.J. Russo, G. Vilagut, J. Almansa, S. Arbabzadeh-Bouchez, J. Autonell, M. Bernal, M.A. Buist-Bouwman, M. Codony, A. Domingo-Salvany, M. Ferrer, S.S. Joo, M. Martinez-Alonso, H. Matschinger, F. Mazzi, Z. Morgan, P. Morosini, C. Palacin, B. Romera, N. Taub, W.A. Vollebergh, Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr. Scand. 190(s420), 21–27 (2004). doi:10.1111/j.1600-0047.2004.00327.x
M. Moore, H.M. Yuen, N. Dunn, M.A. Mullee, J. Maskell, T. Kendrick, Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. BMJ 339, b3999 (2009). doi:10.1136/bmj.b3999
P. Lockhart, B. Guthrie, Trends in primary care antidepressant prescribing 1995–2007: a longitudinal population database analysis. Br. J. Gen. Pract. 61(590), e565–e572 (2011). doi:10.3399/bjgp11X593848
R. Rizzoli, C. Cooper, J.Y. Reginster, B. Abrahamsen, J.D. Adachi, M.L. Brandi, O. Bruyere, J. Compston, P. Ducy, S. Ferrari, N.C. Harvey, J.A. Kanis, G. Karsenty, A. Laslop, V. Rabenda, P. Vestergaard, Antidepressant medications and osteoporosis. Bone 51(3), 606–613 (2012). doi:10.1016/j.bone.2012.05.018
O. Spigset, B. Martensson, Fortnightly review: drug treatment of depression. BMJ 318(7192), 1188–1191 (1999)
E.M. Haney, S.J. Warden, M.M. Bliziotes, Effects of selective serotonin reuptake inhibitors on bone health in adults: time for recommendations about screening, prevention and management? Bone 46(1), 13–17 (2010). doi:10.1016/j.bone.2009.07.083
P. Ducy, G. Karsenty, The two faces of serotonin in bone biology. J. Cell Biol. 191(1), 7–13 (2010). doi:10.1083/jcb.201006123
E.M. Haney, S.J. Warden, Skeletal effects of serotonin (5-hydroxytryptamine) transporter inhibition: evidence from clinical studies. J. Musculoskelet. Neuronal Interact. 8(2), 133–145 (2008)
S.J. Diem, T.L. Blackwell, K.L. Stone, K. Yaffe, E.M. Haney, M.M. Bliziotes, K.E. Ensrud, Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch. Intern. Med. 167(12), 1240–1245 (2007). doi:10.1001/archinte.167.12.1240
L.J. Williams, M.J. Henry, M. Berk, S. Dodd, F.N. Jacka, M.A. Kotowicz, G.C. Nicholson, J.A. Pasco, Selective serotonin reuptake inhibitor use and bone mineral density in women with a history of depression. Int. Clin. Psychopharmacol. 23(2), 84–87 (2008). doi:10.1097/YIC.0b013e3282f2b3bb
E.M. Haney, B.K. Chan, S.J. Diem, K.E. Ensrud, J.A. Cauley, E. Barrett-Connor, E. Orwoll, M.M. Bliziotes, Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch. Intern. Med. 167(12), 1246–1251 (2007). doi:10.1001/archinte.167.12.1246
R. Ginzburg, E. Rosero, Risk of fractures with selective serotonin-reuptake inhibitors or tricyclic antidepressants. Ann. Pharmacother. 43(1), 98–103 (2009). doi:10.1345/aph.1L264
S. Schwan, P. Hallberg, SSRIs, bone mineral density, and risk of fractures—a review. Eur. Neuropsychopharmacol. 19(10), 683–692 (2009). doi:10.1016/j.euroneuro.2009.05.001
V. Rabenda, O. Bruyere, J.Y. Reginster, Risk of nonvertebral fractures among elderly postmenopausal women using antidepressants. Bone 51(4), 674–679 (2012). doi:10.1016/j.bone.2012.07.030
M.S. Bakken, A. Engeland, L.B. Engesaeter, A.H. Ranhoff, S. Hunskaar, S. Ruths, Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian Prescription Database and the Norwegian Hip Fracture Registry. Age Ageing 42(4), 514–520 (2013). doi:10.1093/ageing/aft009
D. Prieto-Alhambra, H. Petri, J.S. Goldenberg, T.P. Khong, O.H. Klungel, N.J. Robinson, F. de Vries, Excess risk of hip fractures attributable to the use of antidepressants in five European countries and the USA. Osteoporos. Int. 25(3), 847–855 (2014). doi:10.1007/s00198-013-2612-2
C. Moura, S. Bernatsky, M. Abrahamowicz, A. Papaioannou, L. Bessette, J. Adachi, D. Goltzman, J. Prior, N. Kreiger, T. Towheed, W.D. Leslie, S. Kaiser, G. Ioannidis, L. Pickard, L.A. Fraser, E. Rahme, Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS). Osteoporos. Int. 25(5), 1473–1481 (2014). doi:10.1007/s00198-014-2649-x
J.J. Gagne, A.R. Patrick, H. Mogun, D.H. Solomon, Antidepressants and fracture risk in older adults: a comparative safety analysis. Clin. Pharmacol. Ther. 89(6), 880–887 (2011). doi:10.1038/clpt.2011.54
G. Mazziotti, J. Bilezikian, E. Canalis, D. Cocchi, A. Giustina, New understanding and treatments for osteoporosis. Endocrine 41(1), 58–69 (2012). doi:10.1007/s12020-011-9570-2
J.F. Griffith, H.K. Genant, New advances in imaging osteoporosis and its complications. Endocrine 42(1), 39–51 (2012). doi:10.1007/s12020-012-9691-2
Q. Wu, W. Qu, M.D. Crowell, J.G. Hentz, K.A. Frey, Tricyclic antidepressant use and risk of fractures: a meta-analysis of cohort and case-control studies. J. Bone Miner. Res. 28(4), 753–763 (2013). doi:10.1002/jbmr.1813
V. Rabenda, D. Nicolet, C. Beaudart, O. Bruyere, J.Y. Reginster, Relationship between use of antidepressants and risk of fractures: a meta-analysis. Osteoporos. Int. 24(1), 121–137 (2013). doi:10.1007/s00198-012-2015-9
C.S. Eom, H.K. Lee, S. Ye, S.M. Park, K.H. Cho, Use of selective serotonin reuptake inhibitors and risk of fracture: a systematic review and meta-analysis. J. Bone Miner. Res 27(5), 1186–1195 (2012). doi:10.1002/jbmr.1554
L.H. Oderda, J.R. Young, C.V. Asche, G.A. Pepper, Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Ann. Pharmacother. 46(7–8), 917–928 (2012). doi:10.1345/aph.1Q589
J.Y. Reginster, R. Deroisy, I. Paul, M. Hansenne, M. Ansseau, Depressive vulnerability is not an independent risk factor for osteoporosis in postmenopausal women. Maturitas 33(2), 133–137 (1999)
C.V. Phillips, K.J. Goodman, The missed lessons of Sir Austin Bradford Hill. Epidemiol. Perspect. Innov. 1(1), 3 (2004). doi:10.1186/1742-5573-1-3
M.W. van den Brand, S. Pouwels, M.M. Samson, T.P. van Staa, B. Thio, C. Cooper, H.G. Leufkens, A.C. Egberts, H.J. Verhaar, F. de Vries, Use of anti-depressants and the risk of fracture of the hip or femur. Osteopor. Int. 20(10), 1705–1713 (2009). doi:10.1007/s00198-009-0849-6
P. Vestergaard, D. Prieto-Alhambra, M.K. Javaid, C. Cooper, Fractures in users of antidepressants and anxiolytics and sedatives: effects of age and dose. Osteoporos. Int. 24(2), 671–680 (2013). doi:10.1007/s00198-012-2043-5
J.M. Robine, E. Cambois, W. Nusselder, B. Jeune, H.V. Oyen, C. Jagger, The joint action on healthy life years (JA: EHLEIS). Arch. Public Health 71(1), 2 (2013). doi:10.1186/0778-7367-71-2
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bruyère, O., Reginster, JY. Osteoporosis in patients taking selective serotonin reuptake inhibitors: a focus on fracture outcome. Endocrine 48, 65–68 (2015). https://doi.org/10.1007/s12020-014-0357-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-014-0357-0
Keywords
- Depression
- Osteoporosis
- Fracture
- Antidepressants
- Selective serotonin reuptake inhibitors