Maudsley Hospital & Institute of Psychiatry, King's College London, London, UK.
Eur Psychiatry. 2012 Apr;27(3):156-69. doi: 10.1016/j.eurpsy.2010.10.006. Epub 2011 Feb 3.
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.
选择性 5-羟色胺再摄取抑制剂（SSRIs）是一组广泛应用的抗抑郁药（ADs），据报道它们可能对骨密度（BMD）产生有害影响，并增加骨折风险。在这里，我们使用医学搜索引擎 MEDLINE（1950 年至 2010 年 9 月）和 EMBASE（1980 年至 2010 年 9 月）对迄今为止的体外、体内和临床研究进行了全面综述。已经在破骨细胞、成骨细胞和骨细胞系上鉴定出了 5-羟色胺（5-HT）受体。SSRI 对骨形成和吸收的影响似乎是通过成骨细胞和破骨细胞上的许多 5-HT 受体的激活来调节的，这些受体通过内分泌、自分泌/旁分泌和神经元途径发挥作用。体外、体内和临床综合数据似乎表明，SSRIs 在治疗剂量水平下对骨骼具有负面影响，而目前的临床实践中广泛用于治疗抑郁症。因此，在有跌倒和骨质疏松风险增加的患者中使用 SSRIs 时可能需要谨慎。需要进一步的研究来充分阐明 SSRIs 在骨形成中的作用及其在低雌激素状态下的作用。
