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

Depression is one of the most important mental health problems and a leading cause of disability. Selective serotonin reuptake inhibitors (SSRIs) are considered as first-line therapy for the treatment of depressive symptoms among older adults because of their presumed favorable adverse effect profile. However, they could have deleterious effects on the bone. Evidence from longitudinal, cross-sectional, and prospective cohort studies suggests that the use of antidepressants at therapeutic doses is associated with decreased bone mineral density and increased fracture risk. The association between SSRIs use and fracture risk could potentially differ depending on dose, exposure duration, time of exposure, age, or sex. However, the risk of fracture declined rapidly after discontinuation of use of SSRIs. The evidence now seems sufficient to consider adding SSRIs to the list of medications that contribute to osteoporosis. In practice, assessment of risk factor for osteoporosis or fractures could be made taking into account age, gender, duration, and severity of depression, length of SSRI treatments, and other concurrent risk factors.