Osteoporosis in patients taking selective serotonin reuptake inhibitors: a focus on fracture outcome

Depression is one of the most important mental
health problems and a leading cause of disability. Selective
serotonin reuptake inhibitors (SSRIs) are considered as
first-line therapy for the treatment of depressive symptoms
among older adults because of their presumed favorable
adverse effect profile. However, they could have deleterious
effects on the bone. Evidence from longitudinal, crosssectional,
and prospective cohort studies suggests that the
use of antidepressants at therapeutic doses is associated
with decreased bone mineral density and increased fracture
risk. The association between SSRIs use and fracture risk
could potentially differ depending on dose, exposure
duration, time of exposure, age, or sex. However, the risk
of fracture declined rapidly after discontinuation of use of
SSRIs. The evidence now seems sufficient to consider
adding SSRIs to the list of medications that contribute to
osteoporosis. In practice, assessment of risk factor for
osteoporosis or fractures could be made taking into account
age, gender, duration, and severity of depression, length of
SSRI treatments, and other concurrent risk factors.