Antidepressants and Bone Loss: No Association in Middle-Aged Women

Summary and Comment |
October 1, 2013

Antidepressants and Bone Loss: No Association in Middle-Aged Women

  1. Peter Roy-Byrne, MD

Results from a large prospective study of the population most vulnerable to bone loss

  1. Peter Roy-Byrne, MD

Antidepressants may lead to increased bone loss, but the several studies on this topic have had cross-sectional designs or prospective designs with many years between assessments. The current research group used 10 years of data gathered annually on 1972 middle-aged menstruating women (baseline age range, 42–52) from the Study of Women's Health Across the Nation to examine possible associations between new use of selective serotonin reuptake inhibitors (311 women) or tricyclic antidepressants (71 women) and subsequent changes in bone mineral density (BMD) at hip, femoral neck, and lumbar spine.

BMD decreased less than 1% annually, and decreases were similar in antidepressant users and the 1590 nonusers. The results were unchanged after controlling for baseline depression before antidepressant initiation, menopausal status, hormone use, race, age, body-mass index, and other medications taken.


This study has the most detailed, prospective data of this type of analysis and seems to show lack of risk for bone loss with antidepressants in the population most vulnerable to this potential effect — i.e., peri- and postmenopausal women. Discrepant earlier findings might have been due to confounding by indication, because recent studies suggest that depression itself is associated with bone loss, even in the absence of antidepressant medication. The lack of antidepressant-associated effect on bone loss may not apply to elderly women, as another study found such an effect in much older women (mean age, 78; Arch Intern Med 2007; 167:1240). Clinicians need not avoid antidepressants in middle-aged female patients out of concerns about bone-loss effects of these medications.

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Treasurer)


Reader Comments (1)

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nice research

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