The Pharmaceutical Journal
Vol 279 No 7459 p5
7 July 2007

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SSRIs associated with increased risk of bone loss in older people, find researchers

Further evidence to suggest an increased risk of bone loss in older men and women taking selective serotonin reuptake inhibitors (SSRIs) is presented in two studies published in the Archives of Internal Medicine (2007;167:1240 and 1246).

The first study assessed use of SSRIs and tricyclic antidepressants (TCAs), and obtained bone mineral density (BMD) measurements over an average of 4.9 years in 2,722 women aged 65 years or older. The women were categorised as non-users, SSRI users or TCA users.

The researchers say that, after adjusting for potential confounders, the mean total hip BMD decreased by 0.47 per cent per year in the non-users compared with 0.82 per cent in SSRI users (P<0.001) and 0.47 per cent in TCA users (P=0.99).

“Our findings suggest that, in this cohort, use of SSRIs is associated with increased rates of hip bone loss. Although some of this association is likely due to confounding by indication, further investigation of SSRI use and rates of change in BMD in other populations with longer follow-up is warranted given the recent description of serotonin transporters in bone,” they conclude.

In the second study, which involved 5,995 men aged 65 years and older, BMD among SSRI users was 3.9 per cent lower at the hip and 5.9 per cent lower at the lumbar spine compared with BMD in men reporting no antidepressant use (P=0.002 for hip and P<0.001 for spine). The association remained significant when results were adjusted for major confounding factors, say the researchers. There was no difference among TCA users and non-users.

“Because SSRI use is prevalent in the general population, our findings have a potentially important public health impact. If confirmed, people using SSRIs might be targeted for osteoporosis screening and preventive intervention,” the researchers conclude.

The author of an accompanying editorial (ibid, p1231), comments that depression and, in particular, SSRI use should be added to the list of risk factors that prompt clinicians to consider bone health more carefully.