This table shows several recent studies that have found increased fracture rates or decreased bone density in patients taking SSRIs. It is important to recognize that depression itself has been associated with osteoporosis (perhaps due, in part, to decreased exercise, less sun exposure, more cigarette and alcohol use, and an unhealthy diet). But these studies have adjusted for all these known factors and still find an increased risk from SSRIs. Serotonin may have a negative impact on the osteoblasts.
These drugs are used commonly and we really need more research about them in relationship to osteoporosis. The drugs have been very helpful for many people, and we need to see if there are ways to improve the bones for people who need them. Although the risk of fractures should be taken into consideration, at this time there are no recommendations to discontinue these helpful medications in patients who need them for treatment of depression. I think patients who are taking these medications should be given information about the importance of exercise, vitamin D, calcium, smoking, and good nutrition.
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