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.
Ensrud KE. Central nervous system active medications and risk for fractures in older women. Arch Intern Med 2003;163(8):949-57.
Liu B. Use of selective serotonin-reuptake inhibitors of tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 1998;351(9112):1303-7.
Hubbard R. Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Am J Epidemiol 2003;158(1):77-84.
Schneeweiss S. Association between SSRI use and hip fractures and the effect of residual confounding bias in claims database studies. J Clin Psychopharmacol 2004;24(6):632-8.
Vestergaard P. Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporos Int 2006;17(6):807-16.
Diem SJ. Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med 2007;167(12):1240-5.
Haney EM. Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med 2007;167(12):1246-51.
Richards JB. Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med 2007;167(2):188-94.
Ziere G. Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. J Clin Psychopharmacol 2008;28(4):411-7.
Spangler L. Depressive symptoms, bone loss, and fractures in postmenopausal women. J Gen Intern Med 2008;23(5):567-74.
van den Brand MW. Use of anti-depressants and the risk of fracture of the hip or femur. Osteoporos Int 2009.
Updated 4/5/09
