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. 2022 Oct 13;14(6):38564.
doi: 10.52965/001c.38564. eCollection 2022.

The use of antidepressants is linked to bone loss: A systematic review and metanalysis

Michele Mercurio  1 , Renato de Filippis  2 , Giovanna Spina  1 , Pasquale De Fazio  2 , Cristina Segura-Garcia  3 , Olimpio Galasso  1 , Giorgio Gasparini  1
Affiliations

The use of antidepressants is linked to bone loss: A systematic review and metanalysis

Michele Mercurio et al. Orthop Rev (Pavia). .

Abstract

Introduction: Depression and antidepressants are among risk factors for osteoporosis. However, there are still inconsistencies in literature regarding bone consequences of antidepressant drugs and the role of age and the natural decline of bone health in patients with depression.

Objective: To investigate the relationship between antidepressant and bone mineral density (BMD).

Methods: We conducted a systematic review and metanalysis according to PRISMA guidelines searching on PubMed/Medline, Cochrane Database, and Scopus libraries and registered with PROSPERO (registration number CRD42021254006) using generic terms for antidepressants and BMD. Search was restricted to English language only and without time restriction from inception up to June 2021. Methodological quality was assessed with the Newcastle-Ottawa scale.

Results: Eighteen papers were included in the qualitative analysis and five in the quantitative analysis. A total of 42,656 participants affected by different subtypes of depression were identified. Among the included studies, 10 used serotonin reuptake inhibitors (SSRIs) only, 6 involved the use of SSRIs and tricyclic antidepressants, and 2 the combined use of more than two antidepressants. No significant studies meeting the inclusion criteria for other most recent categories of antidepressants, such as vortioxetine and esketamine. Overall, we observed a significant effect of SSRI on decrease of BMD with a mean effect of 0.28 (95% CI = 0.08, 0.39).

Conclusion: Our data suggest that SSRIs are associated with a decrease of BMD. We aim to raise clinicians' awareness of the potential association between the use of antidepressants and bone fragility to increase monitoring of bone health.

Keywords: Antidepressants (AD); Bone health; Bone mineral density (BMD); Fracture risk; Selective serotonin reuptake inhibitors (SSRI)..

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Figure 1.
Figure 1.. Literature review and PRISMA flow diagram.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097 For more information, visit www.prisma-statement.org.
Figure 2.
Figure 2.. Analysis of pooled effect of SSRI on decrease of BMD with a mean effect of 0.28 (95% CI = 0.08, 0.39).
See this image and copyright information in PMC

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The authors declare that no funding was received to perform this study.
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