title: Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures.
abstract: 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.
authors.affiliation: 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
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Diem
authors.forename: Terri L
authors.initials: TL
authors.lastname: Blackwell
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Haney
authors.forename: Michael M
authors.initials: MM
authors.lastname: Bliziotes
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: 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
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors