Summary:
Selective serotonin reuptake inhibitors (SSRIs) are a common type of antidepressant drugs that work by stopping the brain from taking serotonin back up too quickly after it is released, which means more serotonin stays available between nerve cells. They also affect serotonin receptors, which changes how nerve cells communicate with each other. Serotonin is not only involved in mood but also plays a role in bone health. Cells that build bone, break down bone, and maintain bone structure all have receptors for serotonin. This means serotonin signals can influence how bone is formed and broken down. Because of this, medicines that change serotonin levels, like SSRIs, may also affect bone strength. This review, a narrative literature review that looked at laboratory studies, animal research, and human studies, examined whether SSRIs affect bone health and if so, how. It found that several studies show people using SSRIs tend to have lower bone mineral density and a higher risk of fractures compared with non-users. These patterns have been seen across different populations, suggesting a consistent association. One possible explanation is that SSRIs may disrupt normal serotonin signalling in bone tissue. This could interfere with the balance between bone building and bone loss over time, leading to weaker bones. Overall, this study suggests that SSRI use may be linked to poorer bone health at standard treatment doses for depression. It also suggests caution in people who already have risk factors for weak bones or falls. However, the exact way SSRIs affect bone is still not fully understood, and more research is needed, especially in groups with hormonal changes such as low oestrogen levels.
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.
Article Publication Date: 15/04/2020
DOI: 10.1016/j.eurpsy.2010.10.006
