In the Journals

Antidepressants appear to accelerate postmenopausal bone loss

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May 17, 2016

In postmenopausal women, the use of tricyclic and selective serotonin reuptake inhibitors were associated with accelerated bone loss, recent study findings show.

“The use of [selective serotonin reuptake inhibitors] seems to accelerate postmenopausal bone loss in a dose-response manner,” Paivi H. Rauma, MPharm, PharmD, of the school of pharmacy in the faculty of health sciences at the University of Eastern Finland and the Kuopo Musculoskeletal Research Unit at the Clinical Research Center in Finland, and colleagues wrote. “A relationship between [tricyclic antidepressants] and other antidepressant use with bone loss may also exist. Thus, the risk for osteoporosis should be considered when antidepressants are prescribed for postmenopausal women.”

Paivi Rauma

Paivi H. Rauma

In a longitudinal study, Rauma and colleagues analyzed data from 1,988 women aged 57 to 67 years participating in the Kuopio Osteoporosis Risk Factor and Prevention study. Women underwent bone mineral density measurements with DXA of the femoral neck in 1999 and 2004 (mean baseline femoral neck BMD, 881 mg/cm²) as well as height, weight and grip strength measurements and completed questionnaires on age of menopause, smoking, alcohol consumption and dietary calcium intake. Antidepressant use data were obtained through the National Prescription Register. Researchers used multiple regression analysis to test associations for anthropometric, medical, physical and lifestyle factors.

During 5 years of follow-up, 319 women purchased antidepressants (16%), 118 (5.9%) used only selective serotonin reuptake inhibitors (SSRIs) and 92 (4.6%) only tricyclic antidepressants. Mean 5-year bone loss for the cohort was 6 mg/cm².

After adjustments, women using tricyclic antidepressants had greater annual BMD loss vs. nonusers (–3.6 mg/cm² vs. –1.1 mg/cm²; P = .031). Researchers also found an association between accelerated bone loss and the use of SSRIs (P = .001). There also was a link between bone loss and the use of other antidepressants in a dose-response way among low-weight women and normal-weight women who lost weight during the study period. Use of combined antidepressants was not associated with bone loss; removing use of other antidepressants did not change results.

“Based on these results, the risk of osteoporosis should be taken into account when antidepressants are prescribed for postmenopausal women,” Rauma told Endocrine Today. “In women with already heightened risk for osteoporosis, long-term treatment of depression with high doses of TCAs and SSRIs should be monitored and interrupted if use is not required.”

The researchers noted that  mixed findings according to antidepressant group may be due to differences in antidepressant mechanisms and binding affinity to transporters and receptors, adding that  different mechanisms of antidepressant action are likely to lead to differing responses in bone cells.” – by Regina Schaffer

For more information:

Paivi H. Rauma, MPharm, PharmD, can be reached at Kuopio Musculoskeletal Research Unit at the University of Eastern Finland, Mediteknia Building, P.O. Box 1627, FIN-70211, Kuopo; email: pr.rauma@gmail.com.

Disclosure: The researchers report no relevant financial disclosures.

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