Selective serotonin reuptake inhibitors (SSRIs) treat depression by inhibiting the protein that transports serotonin, a neurotransmitter involved in sleep and depression, according to background information in the articles. This protein has recently been discovered in bone as well, raising the possibility that SSRIs may affect bone density and the risk of fracture. SSRIs account for about 62 percent of antidepressant prescriptions in the United States, and are often prescribed to the elderly. Here's more from these two studies:
Susan J. Diem, M.D., M.P.H., University of Minnesota, Minneapolis, and colleagues studied 2,722 older women (average age 78.5 years) beginning in 1997 through 1999. At that time and again an average of 4.9 years later, researchers measured women’s total hip bone density and also that of two subregions. At each visit, the participantswere asked to bring in all the medications they had used within the past two weeks, including SSRIs and tricyclic antidepressants, which work through a different mechanism. There was a lower bone density in those who used the SSRI's.As medicine advances, it is not surprising that physicians are finding new ways to improve one health problem while worsening another. My concern in reading these research studies is that instead of finding another, safer way to reduce depression, doctors will add another pharmaceutical chemical to the daily "cocktail" they prescribe for their patients to improve bone density. This increasingly complicated mix of expensive pharmaceutical chemicals serves to help no one with the exception of the pharmaceutical companies that make these products.
“One potential explanation for our findings is that SSRI use may have a direct deleterious effect on bone,” the authors write. “This theory is supported by findings of in vitro and in vivo laboratory investigations.” Some data suggest that SSRIs may interfere with the function of osteoclasts and osteoblasts, cells responsible for the regular breaking down and rebuilding of bone in the body.
In a related paper, Elizabeth M. Haney, M.D., of Oregon Health & Sciences University, Portland, and colleagues conducted a similar study with 5,995 men age 65 and older (average age 73.7). The men’s bone density at the hip, including subregions, and at the base of the spine were measured between 2000 and 2002. Participants were asked to bring all medications to their clinic visit, where they were also given a physical examination and asked about other health and lifestyle factors.
A total of 160 (2.7 percent) men reported using SSRIs, 99 (1.7 percent) reported using tricyclic antidepressants and 52 (0.9 percent) reported using trazodone, a third type of antidepressant. Total hip bone mineral density was 3.9 percent lower among SSRI users than among men who didn’t use any antidepressants. Similarly, spine bone mineral density was 5.9 percent lower among SSRI users than among non-users. There was no significant difference in either hip or spine density between men who took tricyclic antidepressants or trazodone and those who did not take antidepressants.
Although these studies do not prove definitively that SSRIs cause a reduction in bone mineral density, they do raise concerns that physicians must consider when they write prescriptions for antidepressant medications, writes Kenneth Saag, M.D., M.Sc., of the University of Alabama at Birmingham in an accompanying editorial.
For many patients, the benefits of SSRIs are likely to outweight the risks, Dr. Saag continues. “Although it is not appealing to use a second medicine to ‘chase’ the adverse effects of a first one, if needed, there are many good options that exist to prevent bone loss.”
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