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| |  SSRI Use May Correlate With Lower Bone Mineral Density in Middle-Aged Women: Presented at ASBMR By John Otrompke DENVER -- September 13, 2009 -- A study presented at the 31st Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) found that use of some antidepressants may have a correlation with reduced bone mineral density (BMD) in women. While data have been circulated since the late 1990s associating the use of selective serotonin reuptake inhibitors (SSRIs) with an increased risk of hip fractures, the studies have been in elderly women. “They were based on database studies and were not able to control for important variables such as bone density and other health conditions,” said Susan Diem, MD, University of Minnesota, Minneapolis, Minnesota, on September 12. “Basic science data in the last few years have also found that serotonin transcriptors may exist on bone cells. SSRIs, which block serotonin transcription, might then have an effect on bone density.” The study looked at 3,302 women aged 42 to 52 years who were either premenopausal or early menopausal, 1,781 of whom were followed up through to their fourth annual examination. The cohort was part of the population included in the Study of Women’s Health Across the Nation (SWAN), the primary purpose of which was to assess bone density changes in women who are transitioning through menopause. Of the patients in the analysis, 1,644 were non-SSRI users, while 137 women were SSRI users, defined as those using SSRIs twice a week in the month prior to the visit. Individual drug use within the user category included fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram. BMD was measured at the lumbar spine and hip. At the lumbar spine, the mean BMD was 1057 in non-SSRI users compared with 1050 in women who used SSRIs. Measured at the total hip, the figure was 945 in non-users, compared with 952 in non-users, according to the poster. After adjustment for multiple potential confounders, use of SSRIs in this cohort of women in mid-life was associated with lower BMD at the lumbar spine and femoral neck, although the absolute difference in BMD between SSRI users and non-users was small, the study found. When researchers excluded those women taking other antidepressants, the results were similar. When those women were included but controlled for certain differences, the results were also similar. Overall, because of the study’s observational design, it was unable to establish a causal relationship between SSRI use and lower BMD. “Women who are depressed may be less physically active, or they may have a medical condition making them depressed,” explained Dr. Diem. “In addition, there are certain physiological changes associated with depression: they may have a higher level of circulating steroids, or experience the activation of the central nervous system.” [Presentation title: Use of Selective Serotonin Reuptake Inhibitors and Bone Mineral Density in Middle-Aged Women. Abstract A0900130]
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