Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures.
BACKGROUND
Serotonin transporters have recently been described in bone, raising the possibility that medications that block serotonin reuptake could affect bone metabolism.


METHODS
We assessed current use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) and obtained serial bone mineral density (BMD) measurements in a cohort of 2722 older women (mean age, 78.5 years) participating in the Study of Osteoporotic Fractures, a prospective cohort study of community-dwelling women. Hip BMD was measured at the sixth examination and an average of 4.9 years later at the eighth examination. We categorized women as nonusers (used no SSRIs or TCAs at either examination; n=2406), SSRI users (used SSRIs but no TCAs at either examination; n=198), or TCA users (used TCAs but no SSRIs at either examination; n=118). Depressive symptoms were identified using a cutoff score of at least 6 on the Geriatric Depression Scale.


RESULTS
After adjustment for potential confounders, including the Geriatric Depression Scale score, mean total hip BMD decreased 0.47% per year in nonusers compared with 0.82% in SSRI users (P<.001) and 0.47% in TCA users (P=.99). Higher rates of bone loss were also observed at the 2 hip subregions for SSRI users. Results were not substantially altered when women who scored at least 6 on the Geriatric Depression Scale were excluded from the analysis.


CONCLUSIONS
Use of SSRIs but not TCAs is associated with an increased rate of bone loss at the hip in this cohort of older women.
Diem
Susan J
SJ
Department of Medicine, University of Minnesota, and Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, 1100 Washington Ave S, Suite 201, Minneapolis, MN 55415, USA. sdiem@umn.edu
Blackwell
Terri L
TL
Stone
Katie L
KL
Yaffe
Kristine
K
Haney
Elizabeth M
EM
Bliziotes
Michael M
MM
Ensrud
Kristine E
KE
D015502:Absorptiometry, Photon; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D001862:Bone Resorption / Q000139:chemically induced* / Q000150:complications / Q000378:metabolism; D003863:Depression / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D015994:Incidence; D010024:Osteoporosis / Q000139:chemically induced* / Q000150:complications / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors