The adverse skeletal effects of selective serotonin reuptake inhibitors

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are a widely used group of antidepressants (ADs) with reported potential detrimental effects on bone mineral density (BMD) and increased fracture risk. Here, a comprehensive review of the in vitro, in vivo and clinical studies to date was carried out using the medical search engines MEDLINE (1950 to September 2010) and EMBASE (1980 to September 2010). Serotonin (5-HT) receptors have been identified on osteoclast, osteoblast and osteocyte cell lines. The effect of SSRIs on bone formation and resorption appears to be governed by the activation of a number of 5-HT receptors on osteoblasts and osteoclasts via endocrine, autocrine/paracrine and neuronal pathways. In vitro, in vivo and clinical collective data appears to indicate that SSRIs have a negative effect on bone at the therapeutic dose levels widely used for the treatment of depression in current clinical practice. Caution may therefore have to be employed with the use of SSRIs in patients at an increased risk of falls and osteoporosis. Further studies are needed in order to fully elicit the role of SSRIs in bone formation and their effects in the low oestrogen state.

Risk of Vertebral Fracture in Patients Diagnosed with a Depressive Disorder: A Nationwide Population-Based Cohort Study

“…Bolton et al reported that selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines were associated with greater risks of falls and fractures in a dose–effect relationship 36. Antidepressants have been associated with increased bone loss and fracture through the activation of 5-HT receptors on osteoblasts and osteoclasts via endocrine, autocrine/paracrine and neuronal pathways 37,38. Other studies have suggested that all antidepressant classes (tricyclic antidepressants, SSRIs, and other antidepressants) are associated with greater risks of falls and fractures 39-41.…”

Osteoporoza prouzrokovana lekovima

“…Kod starijih pacijenata muške populacije promene su bile više izražene u kičmi (5,9%) i kuku (3,9%) u odnosu na netretirane pacijente [4,5,39]. Neke od studija pokazuju da je rizik od preloma uopšte za 60% veći kod pacijenata koji su na antidepresivnoj terapiji od onih koji to nisu i da je rizik od preloma kod pacijenata koji se leče serotoninergičkim inhibitorima (SSRI) za 35% veći nego kod pacijenata koji su na terapiji ostalim antidepresivima [39], u dozama koje se koriste za lečenje depresije [40]. Nedvosmislena povezanost depresije, antidepresiva i preloma [40] ukazuje na najveći rizik u početnom stadijumu lečenja depresije sa pikom u prvom mesecu za triciklične i osmom mesecu za SSRI antidepresive.…”

“…Neke od studija pokazuju da je rizik od preloma uopšte za 60% veći kod pacijenata koji su na antidepresivnoj terapiji od onih koji to nisu i da je rizik od preloma kod pacijenata koji se leče serotoninergičkim inhibitorima (SSRI) za 35% veći nego kod pacijenata koji su na terapiji ostalim antidepresivima [39], u dozama koje se koriste za lečenje depresije [40]. Nedvosmislena povezanost depresije, antidepresiva i preloma [40] ukazuje na najveći rizik u početnom stadijumu lečenja depresije sa pikom u prvom mesecu za triciklične i osmom mesecu za SSRI antidepresive. Analizirajući 19 objavljenih studija, jedan pregledni članak i jednu meta analizu, Sansone sugeriše da antidepresivi imaju negativne efekte na kost, delimično smanjujući gustinu ili povećavajuči rizik od preloma, te da bi serotonin mogao imati važnu regulatornu ulogu u modelovanju kosti [41].…”

Dental Implants in the Medically Compromised Patient Population

“…including bones because of having serotonin receptors [96]. Therefore, SSRI blocks on bone cells have been reported to affect bone formation negatively [97].…”