From the Research
SSRIs and SNRIs may increase the risk of osteoporosis and fractures, particularly with long-term use, as evidenced by the most recent and highest quality study available 1. The mechanism behind this association involves serotonin's role in bone metabolism, as serotonin receptors are present on bone cells. When these medications block serotonin reuptake, they can interfere with normal bone remodeling processes, potentially leading to decreased bone mineral density over time. Key points to consider include:
- The risk appears to be dose-dependent and more significant with prolonged treatment exceeding one year.
- The risk seems more pronounced in older adults, postmenopausal women, and those with other osteoporosis risk factors.
- Current use of serotonergic antidepressants, including SSRIs and SNRIs, is associated with an increased risk of fracture, as shown in a study using a nationwide representative cohort of ethnic Chinese 2.
- Inadequate daily micronutrient intake, particularly of calcium, vitamin D, and potassium, is common among SSRI users and non-users, and may contribute to lower bone mineral density 3.
- Assessment of risk factors for osteoporosis or fractures should take into account age, gender, duration, and severity of depression, length of SSRI treatments, and other concurrent risk factors 4. Patients taking these medications long-term should consider discussing bone health with their healthcare provider, who might recommend:
- Calcium and vitamin D supplementation
- Weight-bearing exercise
- Bone density testing
- Adjustments to medication if appropriate However, patients should not discontinue these medications without medical consultation, as the benefits for treating depression and anxiety often outweigh the potential bone health risks for many individuals.