Association of Low Bone Mineral Density With Selective Serotonin Reuptake Inhibitor Use by Older Men
Abstract
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are a widely used class of antidepressants that block the serotonin transporter. Osteoblasts and osteocytes express functional serotonin transporters; serotonin transporter gene disruption in mice results in osteopenia; and SSRI use has been associated with increased risk of hip fracture. METHODS: To determine whether SSRI use is associated with lower bone mineral density (BMD) in older men and to compare the results for SSRIs with those of other antidepressants, we performed a cross-sectional analysis of data from 5995 men 65 years and older participating in the prospective cohort Osteoporotic Fractures in Men Study. Main outcome measures included medication use; BMD at the femoral neck, greater trochanter, and lumbar spine measured by dual-energy x-ray absorptiometry; and potential covariates. RESULTS: In adjusted analyses, mean BMD among SSRI users (n=160) was 3.9% lower at the total hip and 5.9% lower at the lumbar spine compared with BMD in men reporting no antidepressant use (n=5708 [P=.002 for total hip; P<.001 for lumbar spine]). There was no significant difference among users of trazodone hydrochloride (n=52) or tricyclic antidepressants (n=99) compared with nonusers. Adjusting for variables that could be associated with BMD and/or SSRI use did not significantly alter these results. The observed difference in BMD for SSRIs is similar to that seen with glucocorticoids. CONCLUSIONS: In this population of men, BMD was lower among those reporting current SSRI use, but not among users of other antidepressants. Further research is needed to confirm this finding in light of widespread SSRI use and potentially important clinical implications.
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SSRI use is associated with low bone mineral density.
“SSRI use has also been associated with low bone mineral density [92,93], as well as an increased risk of fractures [94] and hyponatremia [95].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [92]
This finding seems to be restricted to the SSRI class of antidepressants.
“However, this finding seems to be restricted to the SSRI class of AD (500-502).”
From Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care (2011) · cites this paper as [502]
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- Authors
- Haney, E. M.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Haney, Elizabeth M.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2007-06-25
- Volume
- 167
- Issue
- 12
- Pages
- 1246
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2042156452
- Cited by
- 286
- References
- 35
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 10 · 2020: 6 · 2019: 8 · 2018: 18 · 2017: 8 · 2016: 5 · 2015: 15 · 2014: 12 · 2013: 22 · 2012: 28
- FWCI
- 32.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (U01-AG-18197, U01AG018197)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR45614, U01-AR45632, U01 AR45647, U01AR045583, U01 AR-45583, R01AR052018, U01-AR-45654, K23AR051926, U01AR045580, U01AR045632, U01AR045654, U01AR045614, U01AR045647, U01AR45580)
- National Center for Research Resources (M01RR00334, M01RR000334)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Oncology › Bone health and treatments
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- selective serotonin reuptake inhibitors, bone mineral density, older men, antidepressants, trazodone, tricyclic antidepressants, osteoporosis, hip fracture risk, serotonin transporter, glucocorticoids, Osteoporotic Fractures in Men Study
- MeSH terms
- Aged, Cross-Sectional Studies, Depression, Femur Neck, Follow-Up Studies, Hip, Humans, Lumbar Vertebrae, Male, Middle Aged, Osteoporosis, Prospective Studies, Risk Factors, United States, Absorptiometry, Photon, Bone Density, Incidence, Selective Serotonin Reuptake Inhibitors, Fractures, Bone
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