A recent issue of Archives of Internal Medicine contained two articles suggesting that SSRIs may result in loss of bone density in the elderly. One study was a longitudinal trial, in which 2722 elderly women (average age, 78.5 years) were periodically examined over a 2 year period. Women on SSRIs lost double the bone density of those either on tricyclics or on no antidepressants (Diem SJ et al., 2007;167(12):1240-1245). The other study focused on 5995 elderly men, and was of cross sectional design, examining bone density measurements and antide- pressant usage at a single time point. Men on SSRIs had 4-6% lower bone density than men on no antidepressants (Haney EM et al., 2007;167(12):1240-1245). Both studies controlled for a number of other factors related to osteoporosis, such as physical activity, smoking, and diet.

TCPR’s Take: The main limitation of these findings is that they did not control for the specific effects of depression itself on bone density. Patients on SSRIs are usually depressed, and depression itself has been associated with osteoporosis. On the other hand, the studies did try to control for the presumed mechanisms by which depression may lead to low bone density (such as lack of exercise, poor diet, and smoking). The bottom line is that you need to warn your elderly patients about this potential side effect, even though the findings are still preliminary.