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

Bruyère, Olivier; Reginster, Jean‐Yves

doi:10.1007/s12020-014-0357-0

Cited by 34 publications

(23 citation statements)

References 29 publications

(43 reference statements)

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“…These studies further support the notion that serotonin has a deleterious effect on the skeleton, although it cannot be judged if the negative effect is caused by a central or peripheral effects of the 5‐Htt gene deletion or by the administration of the SSRIs. In line with these experimental observations, secondary osteoporosis has been reported to be an off‐target negative effect caused by the use of SSRIs in humans . SSRI users have substantially lower values of serum serotonin compared with non‐SSRI users, as shown in our study as well as by others .…”

Section: Discussionsupporting

confidence: 92%

High Serum Serotonin Predicts Increased Risk for Hip Fracture and Nonvertebral Osteoporotic Fractures: The MrOS Sweden Study

Kristjánsdóttir

Lewerin

Lerner

et al. 2018

Journal of Bone and Mineral Research

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Because several studies have implicated serotonin as a regulator of bone mass, we here explore its potential association on fracture risk and falls, as on bone mineral density (BMD) and muscle strength, in humans. Serum levels of serotonin were analyzed in 950 men (aged 69 to 81 years), participating in the Gothenburg part of the population‐based study MrOS Sweden. Men taking selective serotonin reuptake inhibitors (SSRIs) had a mean value of 31.2 μg/L compared with 159.4 μg/L in those not taking SSRIs. SSRI users were excluded from further analysis. During 10‐year follow‐up, 224 men exhibited fractures, including 97 nonvertebral osteoporotic fractures (57 hip fractures), and 86 vertebral fractures. Serotonin was associated with hip fracture in linear analysis (hazard ratio [HR] = 1.27, 95% confidence interval [CI] 1.03–1.58) and to all fractures in a nonlinear manner, when quintiles of serotonin was included in quadratic terms (HR = 1.12, 95% CI 1.04–1.21). Men in serotonin quintile 5 had, in multivariable analysis, a HR of 2.30 (95% CI 1.31–4.02) for hip fracture and 1.82 (95% CI 1.17–2.85) for nonvertebral fractures compared with men in quintiles 1 to 4. Men in quintile 1 had, in multivariable analysis, a HR of 1.76 (95% CI 1.03–2.99) for nonvertebral fractures compared with men in quintiles 2 to 4. No association was found with vertebral fractures. Individuals in serotonin quintile 1 had higher prevalence of falls compared with quintiles 2 to 5 (odds ratio = 1.90, 95% CI 1.26–2.87). Serotonin was positively associated with hand‐grip strength (r = 0.08, p = 0.02) and inversely with hip BMD (r = −0.10, p = 0.003). To assess the association between SSRIs and falls and fractures, the total MrOS Sweden cohort was examined (n = 3014). SSRI users (n = 90) had increased prevalence of falls (16% versus 33%, p = 0.0001) and increased rate of incident fractures (28.0 versus 44.7 per 1000 person‐years, p = 0.018). We present novel data showing that high levels of serotonin predict an increased risk for hip fracture and nonvertebral osteoporotic fractures. © 2018 American Society for Bone and Mineral Research.

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Section: Discussionsupporting

confidence: 92%

High Serum Serotonin Predicts Increased Risk for Hip Fracture and Nonvertebral Osteoporotic Fractures: The MrOS Sweden Study

Kristjánsdóttir

Lewerin

Lerner

et al. 2018

Journal of Bone and Mineral Research

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“…A recent point prevalence study demonstrated that over one-third of patients admitted to an orthopaedic ward had non-AFs. 30 This association is even more relevant when we consider that depression, as well as antidepressant use, 33 is independently 34 further increasing the risk of fractures in this vulnerable cohort.…”

Section: Discussionmentioning

confidence: 99%

Does baseline depression increase the risk of unexplained and accidental falls in a cohort of community‐dwelling older people? Data from The Irish Longitudinal Study on Ageing (TILDA)

Briggs

Kennelly

Kenny

2017

Int J Geriat Psychiatry

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“…SSRIs are considered as first-line therapy for the treatment of depressive symptoms among older adults because of their presumed favorable adverse effect profile [34]. However, serotonin transporters have recently been described in bone [14], raising the possibility that medications that block serotonin reuptake could affect bone metabolism.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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

Cited by 34 publications

References 29 publications

High Serum Serotonin Predicts Increased Risk for Hip Fracture and Nonvertebral Osteoporotic Fractures: The MrOS Sweden Study

High Serum Serotonin Predicts Increased Risk for Hip Fracture and Nonvertebral Osteoporotic Fractures: The MrOS Sweden Study

Does baseline depression increase the risk of unexplained and accidental falls in a cohort of community‐dwelling older people? Data from The Irish Longitudinal Study on Ageing (TILDA)

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

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