Antidepressant medications and osteoporosis
Use of antidepressant medications that act on the serotonin system has been linked to detrimental impacts on bone mineral density (BMD), and to osteoporosis. This article reviews current evidence for such effects, and identifies themes for future research. Serotonin receptors are found in all major...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Formato: | Journal article |
| Publicado: |
2012
|
| _version_ | 1826300424680898560 |
|---|---|
| author | Rizzoli, R Cooper, C Cooper, C Reginster, J Abrahamsen, B Adachi, J Brandi, M Bruyère, O Compston, J Ducy, P Ferrari, S Harvey, N Kanis, J Karsenty, G Laslop, A Rabenda, V Vestergaard, P |
| author_facet | Rizzoli, R Cooper, C Cooper, C Reginster, J Abrahamsen, B Adachi, J Brandi, M Bruyère, O Compston, J Ducy, P Ferrari, S Harvey, N Kanis, J Karsenty, G Laslop, A Rabenda, V Vestergaard, P |
| author_sort | Rizzoli, R |
| collection | OXFORD |
| description | Use of antidepressant medications that act on the serotonin system has been linked to detrimental impacts on bone mineral density (BMD), and to osteoporosis. This article reviews current evidence for such effects, and identifies themes for future research. Serotonin receptors are found in all major types of bone cell (osteoblasts, osteocytes, and osteoclasts), indicating an important role of the neuroendocrine system in bone. Observational studies indicate a complex relationship between depression, antidepressants, and fracture. First, the presence of depression itself increases fracture risk, in relation with decreased BMD and an increase in falls. A range of aspects of depression may operate, including behavioral factors (e.g., smoking and nutrition), biological changes, and confounders (e.g., comorbidities and concomitant medications). A substantial proportion of depressed patients receive antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). Some of these have been linked to decreased BMD (SSRIs) and increased fracture risk (SSRIs and tricyclic agents). Current use of SSRIs and tricyclics increases fracture risk by as much as twofold versus nonusers, even after adjustment for potential confounders. While there is a dose-response relationship for SSRIs, the effect does not appear to be homogeneous across the whole class of drugs and may be linked to affinity for the serotonin transporter system. The increase in risk is the greatest in the early stages of treatment, with a dramatic increase after initiation, reaching a peak within 1. month for tricyclics and 8. months for SSRIs. Treatment-associated increased risk diminishes towards baseline in the year following discontinuation. The body of evidence suggests that SSRIs should be considered in the list of medications that are risk factors for osteoporotic fractures. © 2012 Elsevier Inc. |
| first_indexed | 2024-03-07T05:16:58Z |
| format | Journal article |
| id | oxford-uuid:dd899f28-94e5-4a5b-99e8-b7ac26f3b448 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T05:16:58Z |
| publishDate | 2012 |
| record_format | dspace |
| spelling | oxford-uuid:dd899f28-94e5-4a5b-99e8-b7ac26f3b4482022-03-27T09:25:48ZAntidepressant medications and osteoporosisJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:dd899f28-94e5-4a5b-99e8-b7ac26f3b448Symplectic Elements at Oxford2012Rizzoli, RCooper, CCooper, CReginster, JAbrahamsen, BAdachi, JBrandi, MBruyère, OCompston, JDucy, PFerrari, SHarvey, NKanis, JKarsenty, GLaslop, ARabenda, VVestergaard, PUse of antidepressant medications that act on the serotonin system has been linked to detrimental impacts on bone mineral density (BMD), and to osteoporosis. This article reviews current evidence for such effects, and identifies themes for future research. Serotonin receptors are found in all major types of bone cell (osteoblasts, osteocytes, and osteoclasts), indicating an important role of the neuroendocrine system in bone. Observational studies indicate a complex relationship between depression, antidepressants, and fracture. First, the presence of depression itself increases fracture risk, in relation with decreased BMD and an increase in falls. A range of aspects of depression may operate, including behavioral factors (e.g., smoking and nutrition), biological changes, and confounders (e.g., comorbidities and concomitant medications). A substantial proportion of depressed patients receive antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). Some of these have been linked to decreased BMD (SSRIs) and increased fracture risk (SSRIs and tricyclic agents). Current use of SSRIs and tricyclics increases fracture risk by as much as twofold versus nonusers, even after adjustment for potential confounders. While there is a dose-response relationship for SSRIs, the effect does not appear to be homogeneous across the whole class of drugs and may be linked to affinity for the serotonin transporter system. The increase in risk is the greatest in the early stages of treatment, with a dramatic increase after initiation, reaching a peak within 1. month for tricyclics and 8. months for SSRIs. Treatment-associated increased risk diminishes towards baseline in the year following discontinuation. The body of evidence suggests that SSRIs should be considered in the list of medications that are risk factors for osteoporotic fractures. © 2012 Elsevier Inc. |
| spellingShingle | Rizzoli, R Cooper, C Cooper, C Reginster, J Abrahamsen, B Adachi, J Brandi, M Bruyère, O Compston, J Ducy, P Ferrari, S Harvey, N Kanis, J Karsenty, G Laslop, A Rabenda, V Vestergaard, P Antidepressant medications and osteoporosis |
| title | Antidepressant medications and osteoporosis |
| title_full | Antidepressant medications and osteoporosis |
| title_fullStr | Antidepressant medications and osteoporosis |
| title_full_unstemmed | Antidepressant medications and osteoporosis |
| title_short | Antidepressant medications and osteoporosis |
| title_sort | antidepressant medications and osteoporosis |
| work_keys_str_mv | AT rizzolir antidepressantmedicationsandosteoporosis AT cooperc antidepressantmedicationsandosteoporosis AT cooperc antidepressantmedicationsandosteoporosis AT reginsterj antidepressantmedicationsandosteoporosis AT abrahamsenb antidepressantmedicationsandosteoporosis AT adachij antidepressantmedicationsandosteoporosis AT brandim antidepressantmedicationsandosteoporosis AT bruyereo antidepressantmedicationsandosteoporosis AT compstonj antidepressantmedicationsandosteoporosis AT ducyp antidepressantmedicationsandosteoporosis AT ferraris antidepressantmedicationsandosteoporosis AT harveyn antidepressantmedicationsandosteoporosis AT kanisj antidepressantmedicationsandosteoporosis AT karsentyg antidepressantmedicationsandosteoporosis AT laslopa antidepressantmedicationsandosteoporosis AT rabendav antidepressantmedicationsandosteoporosis AT vestergaardp antidepressantmedicationsandosteoporosis |