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SSRIs, bone mineral density, and risk of fractures--a review

Sofie Schwan1, Pär Hallberg

  • 1Uppsala County Council, Uppsala Drug Information Center, Sweden.

European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology
|June 23, 2009
PubMed

Insights

Selective serotonin reuptake inhibitors (SSRIs) may affect bone health, but evidence is inconclusive. Further long-term studies are needed to determine if SSRIs impact bone mineral density and fracture risk.

Area of Science:

  • Pharmacology
  • Bone Biology
  • Epidemiology

Background:

  • Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed antidepressants.
  • A potential link between SSRI use and increased fracture risk has been proposed.
  • SSRIs may influence bone mineral density (BMD), but the mechanism is unclear.

Purpose of the Study:

  • To review and discuss the current evidence regarding SSRIs and bone health.
  • To evaluate the association between SSRIs, BMD, and fracture risk.
  • To identify gaps in current research and suggest future study designs.

Main Methods:

  • Literature review of epidemiological and experimental studies.
  • Analysis of heterogeneous study results on SSRIs, depression, BMD, falls, and fractures.
  • Discussion of the functional 5-HT system in bone.

Main Results:

  • Epidemiological studies show inconsistent associations between SSRIs, depression, BMD, falls, and fractures.
  • Experimental data suggest a functional serotonin system in bone, but its role is not fully understood.
  • Current data are insufficient to establish a causal link between SSRIs and negative bone health outcomes.

Conclusions:

  • It is not possible to definitively conclude whether SSRIs negatively influence bone regulation.
  • SSRIs might be innocent bystanders in the observed associations with bone health.
  • Large, prospective, long-term studies focusing on BMD changes are required to resolve this question.

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