title: Update in serotonin and bone.
abstract: BACKGROUND
  Serotonin (5-HT) may be an important regulatory agent in bone, and agents that modify 5-HT signaling, such as selective serotonin reuptake inhibitors (SSRIs), are in widespread clinical use.
  
  
  METHODS
  Evidence was obtained by PubMed search and the author's knowledge of the field.
  
  
  RESULTS
  Recent data suggest that gut-derived 5-HT may mediate the skeletal effects of LDL receptor-related protein 5, stimulating intense interest in a novel mechanism for regulating bone mass. However, the specific biochemical nature of serotonergic pathways influencing bone and their direct and/or indirect effects on bone metabolism are still unclear. The weight of epidemiological evidence suggests that SSRIs are associated with reduced bone mass, increased bone loss, and increased risk of fractures. Interpretation of these studies is complicated by the confounding effects of depression, the usual indication for treatment with SSRIs. The mechanisms for putative SSRI-induced deleterious effects on the skeleton are unknown, and are likely multifactorial.
  
  
  CONCLUSIONS
  5-HT may have regulatory effects on bone. Initial preclinical data suggest that its effects may be deleterious and may be regulated by low-density lipoprotein receptor-related protein 5. These studies need confirmation, as well as elucidation, of the biochemical pathways utilized and the feedback loops involved among bone, gut, and perhaps brain. Paradoxically, targeting of 5-HT synthesis and/or signaling in selective tissues may hold promise as an anabolic intervention for bone. Epidemiological data suggest that clinicians should be vigilant about detection of bone disease in patients who are using SSRIs.
authors.affiliation: Department of Medicine, Oregon Health & Science University and Portland VA Medical Center, Portland, Oregon 97239, USA. bliziote@ohsu.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Bliziotes
mesh_terms: D000818:Animals; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism / Q000502:physiology*; D002490:Central Nervous System / Q000187:drug effects; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000502:physiology; D026502:LDL-Receptor Related Proteins / Q000502:physiology; D060492:Low Density Lipoprotein Receptor-Related Protein-5; D008954:Models, Biological; D012701:Serotonin / Q000378:metabolism / Q000494:pharmacology / Q000502:physiology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology; D015398:Signal Transduction / Q000187:drug effects
chemical_list: D026502:LDL-Receptor Related Proteins; D060492:Low Density Lipoprotein Receptor-Related Protein-5; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; C555482:LRP5 protein, human
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