title: Depression, antidepressants, and bone health in older adults: a systematic review.
abstract: OBJECTIVE
  To examine the association between depression, antidepressant use, and bone health in older adults and the implications for treatment.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  All studies that measured depression or antidepressant exposure and bone mineral density (BMD).
  
  
  METHODS
  Adults aged 60 and older.
  
  
  METHODS
  Age, site of BMD measurement using dual-energy X-ray absorptiometry (DXA), measure of depression or depressive symptoms, association between BMD changes, and depression or antidepressant use.
  
  
  RESULTS
  Nineteen observational studies met the final inclusion criteria; no experimental studies were found. Several cross-sectional and longitudinal studies found that depression or depressive symptoms were associated with a decrease in BMD. Few studies and only two longitudinal studies addressed the association between serotonin reuptake inhibitor (SRI) antidepressant use and a decrease in BMD and they had conflicting results.
  
  
  CONCLUSIONS
  Depression and depressive symptoms are associated with low bone mass and accelerated bone loss in older adults; putative mechanisms underlying this relationship are discussed. There is insufficient evidence that SRI antidepressants adversely affect bone health. Thus, a change in current recommendations for the use of antidepressants in older adults is not justified at the present time. Given the high public health significance of this question, more studies are required to determine whether (and in whom) antidepressants may be deleterious for bone health.
authors.affiliation: Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri.
authors.forename: Marie Anne
authors.initials: MA
authors.lastname: Gebara
authors.forename: Marcie L O
authors.initials: ML
authors.lastname: Shea
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lipsey
authors.forename: Steven L
authors.initials: SL
authors.lastname: Teitelbaum
authors.forename: Roberto
authors.initials: R
authors.lastname: Civitelli
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Müller
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lenze
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D064887:Observational Studies as Topic; D010024:Osteoporosis / Q000139:chemically induced*
chemical_list: D000928:Antidepressive Agents
keywords: BMD; antidepressants; depression; older adults