Normal Bone Microstructure and Density But Worse Physical Function in Older Women Treated with Selective Serotonin Reuptake Inhibitors, a Cross-Sectional Population-Based Study

Abstract

Depression in the elderly is today often treated with selective serotonin reuptake inhibitors (SSRIs) because of their favorable adverse effect profile. However, treatment with SSRIs is associated with increased risk of fractures. Whether this increased risk depends on reduced bone strength or increased fall risk due to reduced physical function is not certain. The aim was therefore to investigate if treatment with SSRIs is associated with impaired bone microstructure, bone density, or physical function in older women. From an ongoing population-based study, 1057 women (77.7 ± 1.5 years) were included. Validated questionnaires were used to assess information regarding medical history, medications, smoking, mental and physical health, and physical activity. Physical function was measured using clinically used tests: timed up and go, walking speed, grip strength, chair stand test, and one leg standing. Bone mineral density (BMD) was measured at the hip and spine with dual-energy X-ray absorptiometry (Hologic Discovery A). Bone geometry and microstructure were measured at the ultradistal and distal (14%) site of radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT; XtremeCT). Treatment with SSRIs was associated with higher BMD at the femoral neck, total hip, and lumbar spine, whereas no associations were found for any HR-pQCT-derived measurements. The use of SSRIs was associated with lower grip strength, walking speed, and fewer chair stand rises. These associations were valid also after adjustments for known risk factors for falls. Treatment with SSRIs was, independently of covariates, associated with worse physical function without any signs of inferior bone geometry and microstructure.Electronic supplementary materialThe online version of this article (10.1007/s00223-018-0427-z) contains supplementary material, which is available to authorized users.

Extensive undertreatment of osteoporosis in older Swedish women

“…An initial manual screening was performed based on home address, to ensure that the participants were within the right age range and to exclude those residing in special housing. The inclusion and exclusion criteria have been described earlier [ 21 , 22 ]. The study included 3028 elderly women.…”

Current anti-depressant use is associated with cortical bone deficits and reduced physical function in elderly women

“…Skeletal microstructure has only recently begun to be evaluated in those taking anti-depressants. A recent study using high resolution peripheral quantitative computed tomography (HR-pQCT) indicated no association between SSRI use and skeletal microstructure in older women [16]. In contrast, another study assessing bone microstructure using the trabecular bone score (TBS) found SSRI use to be associated with lower TBS but the association was not independent of covariates [23].…”

“…Data regarding the effects of anti-depressants, particularly SSRIs and SNRIs, on the musculoskeletal system in humans are limited. There are conflicting data with regard to the effect of SSRIs on BMD as measured by DXA and few data in SNRI users [15][16][17][18][19][20][21][22]. Skeletal microstructure has only recently begun to be evaluated in those taking anti-depressants.…”

“…Reduced muscular function or mass may play a role in explaining the excess risk of falls and fracture in those taking anti-depressants. A recent study indicated SSRI use was associated with worse physical function including lower grip strength, walking speed and lower extremity proximal muscle strength [16]. It is unclear if SSRIs may also affect muscle mass.…”

Depression and incident hip fracture

“…[26] To support this, selective serotonin reuptake inhibitors were also related to impaired physical activity without decreased bone mineral density or bone microstructure in a population-based study. [27]…”