Department of Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
Bone. 2010 Jan;46(1):13-7. doi: 10.1016/j.bone.2009.07.083. Epub 2009 Aug 5.
Evidence regarding a functional serotonin (5-hydroxytryptamine) signaling system in bone has generated considerable recent interest. The specific biochemical nature of serotoninergic pathways and their direct and/or indirect effects on bone metabolism are still unclear. Clinical evidence supports an effect of serotonin and altered serotonin signaling on bone metabolism. Serotonin is involved in the pathophysiology of depression, and therefore studies of depression and antidepressant treatments (as modulators of the serotonin system) are relevant with regard to bone outcomes. Studies on the effect of depression on bone mineral density (BMD) and fractures have been mixed. Studies on the associations between antidepressant use and BMD and/or fractures are more consistent. SSRIs have been associated with lower BMD and increased rates of bone loss, as well as increased rates of fracture after accounting for falls. These studies are limited by confounding because depression is potentially associated with both the outcome of interest (BMD and fracture) and the exposure (SSRIs). With mounting evidence for an effect on bone, this review considers the question of causality and whether selective serotonin reuptake inhibitors should be considered among those medications that contribute to bone loss, and therefore prompt clinicians to evaluate BMD proactively. Future research will be required to confirm the serotoninergic effects on bone and the biochemical pathways involved, and to identify clinical implications for treatment based on this novel pathway.
关于骨中功能性血清素（5-羟色胺）信号系统的证据引起了最近的极大关注。血清素能途径的特定生化性质及其对骨代谢的直接和/或间接影响仍不清楚。临床证据支持血清素对骨代谢的影响和改变的血清素信号。血清素参与抑郁症的病理生理学，因此，关于抑郁症和抗抑郁治疗（作为血清素系统的调节剂）的研究与骨结局相关。关于抑郁症对骨矿物质密度（BMD）和骨折的影响的研究结果不一。关于抗抑郁药使用与 BMD 和/或骨折之间关联的研究则更为一致。SSRI 与 BMD 降低、骨丢失率增加以及在考虑到跌倒后骨折发生率增加有关。这些研究受到混杂因素的限制，因为抑郁症可能与感兴趣的结果（BMD 和骨折）和暴露（SSRIs）都有关。随着对骨骼的影响的证据越来越多，这篇综述考虑了因果关系的问题，以及选择性 5-羟色胺再摄取抑制剂是否应被视为导致骨丢失的药物之一，因此促使临床医生积极主动地评估 BMD。需要进一步的研究来确认血清素对骨骼的影响及其涉及的生化途径，并根据这一新途径确定治疗的临床意义。
