title: Rates of bone loss among women initiating antidepressant medication use in midlife.
abstract: BACKGROUND
  Concern has been raised that medications that block serotonin reuptake may affect bone metabolism, resulting in bone loss.
  
  
  OBJECTIVE
  The aim of the study was to compare annual bone mineral density (BMD) changes among new users of selective serotonin reuptake inhibitors (SSRIs), new users of tricyclic antidepressants (TCAs), and nonusers of antidepressant medications.
  
  
  METHODS
  We conducted a prospective cohort study at five clinical centers in the United States.
  
  
  METHODS
  The study included 1972 community-dwelling women, aged 42 years and older, enrolled in the Study of Women's Health Across the Nation (SWAN).
  
  
  METHODS
  The use of antidepressant medications was assessed by interview and verified from medication containers at annual visits. Subjects were categorized as nonusers (no SSRI or TCA use at any examination), SSRI users (initiated SSRI use after the baseline SWAN visit), or TCA users (initiated TCA use after the baseline visit), using a computerized dictionary to categorize type of medication.
  
  
  METHODS
  BMD at the lumbar spine, total hip, and femoral neck was measured using dual-energy x-ray absorptiometry at annual visits.
  
  
  RESULTS
  BMD was compared among 311 new users of SSRIs, 71 new users of TCAs, and 1590 nonusers. After adjustment for potential confounders, including age, race, body mass index, menopausal status, and hormone therapy use, mean lumbar spine BMD decreased on average 0.68% per year in nonusers, 0.63% per year in SSRI users (P = .37 for comparison to nonusers), and 0.40% per year in TCA users (P = .16 for comparison to nonusers). At the total hip and femoral neck, there was also no evidence that SSRI or TCA users had an increased rate of bone loss compared with nonusers. Results were similar in subgroups of women stratified by the Center for Epidemiologic Studies Depression Scale (<16 vs ≥16).
  
  
  CONCLUSIONS
  In this cohort of middle-aged women, use of SSRIs and TCAs was not associated with an increased rate of bone loss at the spine, total hip, or femoral neck.
authors.affiliation: MD, MPH, 1100 Washington Avenue South, Suite 201, Minneapolis, Minnesota 55415. sdiem@umn.edu.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Diem
authors.forename: Kristine
authors.initials: K
authors.lastname: Ruppert
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: YinJuan
authors.initials: Y
authors.lastname: Lian
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Bromberger
authors.forename: Joel S
authors.initials: JS
authors.lastname: Finkelstein
authors.forename: Gail A
authors.initials: GA
authors.lastname: Greendale
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000187:drug effects; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors