SSRI and osteoporosis

• two observational studies have suggested that SSRI's might be linked to low bone mineral density
  • in the first study, researchers analysed health data from 5995 men over 65 years old in the USA. They found that bone mineral density was 3.9% lower at the femoral neck and 5.9% lower at the lumbar spine among those reporting current SSRI use, but not among users of other antidepressants (trazodone and tricyclics) (1)
  • in the second study, researchers examined 2,722 women ages 65 and older between 1986 and 1988, and again between 1997 and 1998. The mean total hip bone marrow density decreased 0.47% among participants who did not use SSRIs, but by 0.82% among people who did take the drugs (2)
• a Canadian case-control study showed that in people over the age of 50 who have suffered a fracture, selective serotonin reuptake inhibitors (SSRIs) were associated with the highest adjusted odds of osteoporotic fractures (OR 1.45, 95% CI 1.32 to 1.59). Monoamine oxidase inhibitors (OR 1.15, 95% CI, 1.07 to 1.24) and benzodiazepines (OR 1.10, 95% CI, 1.04 to 1.16) were associated with a smaller excess fracture risk compared with SSRIs. Lithium appeared to have a protective effect (OR 0.63, 95% CI 0.43 to 0.93), whereas the relationship between antipsychotics and fracture was not significant (3)

People over the age of 50 on long-term antidepressant therapy (in particular SSRIs) may be considered for fracture-risk assessment, particularly in the presence of other risk factors (4)

Reference:

1. Haney EM; Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med. 2007 Jun 25; 167(12):1246-51
2. Diem SJ et al; Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med. 2007 Jun 25; 167(12):1240-5
3. Vestergaard P, Rejnmark L, Mosekilde L. Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporosis International 2006;17(6):807-16
4. SIGN (June 2020). Management of osteoporosis and the prevention of fragility fractures