title: Effects of escitalopram on markers of bone turnover: a randomized clinical trial.
abstract: BACKGROUND
  Recent observational studies have suggested that the use of selective serotonin reuptake inhibitors is associated with an increased fracture risk and an accelerated bone loss, although conflicting results have been reported. Furthermore, because many of these studies have been performed in depressed women, confounding by indication may influence these findings.
  
  
  OBJECTIVE
  The objective of the study was to determine whether selective serotonin reuptake inhibitors affect bone metabolism Design: This was a randomized controlled trial.
  
  
  METHODS
  The study was conducted in four US clinical sites.
  
  
  METHODS
  Healthy peri- and postmenopausal women participated in the study.
  
  
  METHODS
  The intervention was escitalopram (10-20 mg/d) for the treatment of vasomotor symptoms.
  
  
  METHODS
  Serum carboxyterminal collagen crosslinks (CTX) and serum amino-terminal propeptide of type I collagen (P1NP) were measured.
  
  
  RESULTS
  One hundred forty-one peri- or postmenopausal nondepressed women (mean age 53.7 y, SD 4.1) had baseline and 8-week follow-up samples available for analysis and were included in the study (69 escitalopram, 72 placebo). The groups were balanced across a broad range of baseline characteristics, including age, race, body mass index, smoking status, and mood symptoms. The between-group differences in the change in CTX and P1NP from baseline to week 8 were compared by a repeated-measures linear regression model adjusted for race, clinical center, and baseline measurement. Treatment with escitalopram reduced serum P1NP by 1.02 ng/mL on average [95% confidence interval (CI) -5.17, 3.12] compared with a reduction of 1.88 ng/mL (95% CI -4.82, 1.06) in the placebo group (P = .65). Similarly, serum CTX decreased 0.02 ng/mL on average (95% CI -0.05, 0.01) in the escitalopram group compared with 0.00 ng/mL (95% CI -0.02, 0.02) in the placebo group (P = .24). The results were similar when the analysis was restricted to those women whose adherence to study medication was 70% or greater.
  
  
  CONCLUSIONS
  Although the study was limited to 8 weeks, these results suggest that escitalopram does not significantly alter bone metabolism in the short term.
authors.affiliation: University of Minnesota (S.J.D., K.E.E.), Minneapolis, Minnesota 55415; Brigham and Women's Hospital and Dana Farber Cancer Institute (H.J.), Boston, Massachusetts 02115; Fred Hutchinson Cancer Research Center (J.C.L., A.Z.L.), Seattle, Washington 98109; Massachusetts General Hospital (J.N.T., B.Z.L.), Boston, Massachusetts 02114; Minneapolis Veterans Affairs Health Care System (K.E.E.), Minneapolis, Minnesota 55417; and Perelman School of Medicine (E.W.F.), University of Pennsylvania, Philadelphia, Pennsylvania 19104.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Diem
authors.forename: Hadine
authors.initials: H
authors.lastname: Joffe
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Larson
authors.forename: Joy N
authors.initials: JN
authors.lastname: Tsai
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Freeman
authors.forename: Benjamin Z
authors.initials: BZ
authors.lastname: Leder
mesh_terms: D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects*; D015283:Citalopram / Q000008:administration & dosage* / Q000009:adverse effects*; D024042:Collagen Type I / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D064368:Healthy Volunteers; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000139:chemically induced*; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D010919:Placebos; D017698:Postmenopause; D011347:Procollagen / Q000097:blood; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D015283:Citalopram; D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D010919:Placebos; D011347:Procollagen; D017367:Selective Serotonin Reuptake Inhibitors; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide