Health A to Z

Seniors' Health: Antidepressants linked with bone loss

Researchers advise patients to discuss the risks and benefits of treatment with their doctor

Two recent studies raise concerns that older men and women using antidepressants called selective serotonin reuptake inhibitors (SSRIs) may have higher rates of bone loss — a situation that could set them up for an increased risk of fractures.

SSRIs include medications sold under generic names such as fluoxetine, paroxetine and sertraline, as well as brand names such as Prozac, Paxil and Zoloft.

The study authors caution that their findings simply demonstrate a link between SSRIs and weakened bones, and don’t prove a cause-and-effect relationship. Nonetheless, they suggest older people taking this popular type of antidepressant should pay attention to their bone health.

In one of the studies, Dr. Susan Diem of the University of Minnesota in Minneapolis found an increased rate of bone loss at the hip in women taking SSRIs compared with those taking other antidepressants called tricyclics, or those not taking antidepressants. The study involved more than 2,700 women with an average age of 79 years.

“What’s not known yet is whether that degree of bone loss (observed in SSRI users) translates into an increased risk of fractures, which is the real thing we’re concerned about,” Diem says. “Our work also cannot determine whether the SSRIs themselves are responsible for the increased rate of loss or whether there are other differences in SSRI users and people not on the drugs that explain the increased rate. So given those limitations right now, I don’t think that patients should overreact or stop taking their antidepressant medications.”

In a similar study, Dr. Elizabeth Haney of the Oregon Health and Science University in Portland, Ore., measured bone density in nearly 6,000 men age 65 years and older. Bone density at the hip and spine was an average of four to six per cent lower among SSRI users than among men who did not take antidepressants.

Haney says people using SSRIs should not “jump to conclusions” about the study findings but should talk to their doctors in order to weigh the risks and benefits of using this type of medication. “In some cases, depression will be best treated by an SSRI. When that’s the case, it may be worth paying attention to prevention of bone loss. But that’s an individual physician’s decision with their patient.”