3 studies link use of SSRIs to bone loss

Heightened bone health vigilance, including an annual scan, is suggested for patients on these popular antidepressants.

By Susan J. Landers, AMNews staff. July 23/30, 2007.

Washington -- A commonly prescribed class of antidepressants, selective serotonin reuptake inhibitors, has been associated with bone loss in older men and women in at least three large studies published over recent months.

This suspected risk should inspire increased vigilance by physicians regarding who is prescribed these medications and for how long. But for now, no major change in SSRI use is indicated or even advisable, according to several experts.

The growing evidence now supports at least a preliminary recommendation that depression and SSRI use should be added to the list of risk factors that prompt clinicians to consider bone health more carefully, said Kenneth Saag, MD, associate professor of medicine at the University of Alabama in Birmingham, in a June 25 Archives of Internal Medicine editorial. Two of the SSRI studies appear in that journal issue.

The findings also bring more attention to the need to treat two commonly diagnosed conditions among older patients: depression and osteoporosis.

Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55% of those 50 years old and older, according to the National Osteoporosis Foundation. And depression is increasingly seen among older adults, based on National Institute of Mental Health statistics.

But it's still a little early to worry about the risk posed by SSRIs to bone health, said Felicia Cosman, MD, medical director for the osteoporosis foundation. "We really don't have a good understanding of the degree of risk these agents will pose," she said. "We wouldn't want people to think they had to stop their antidepressant because it is going to cause bone loss."