Sansone Randy A, Sansone Lori A
Departments of Psychiatry and Internal Medicine, Wright State University School of Medicine, Dayton, Ohio, USA.
Innov Clin Neurosci. 2012 Jul;9(7-8):42-7.
Selective serotonin reuptake inhibitors are globally popular antidepressants with broad clinical indications. Despite an overall favorable side-effect profile, our examination of 19 studies, one review, and one meta-analysis indicates that these unique antidepressants appear to have negative effects on bone, particularly with regard to bone mineral density and fracture risk. These risks may be enhanced by more serotonergic agents and/or longer exposure to selective serotonin reuptake inhibitors. The magnitude of this relationship is difficult to determine due to the myriad of potential confounds in available studies, but all indicate risk. In additional support of these findings, serotonin receptors have been identified on osteoclasts, osteoblasts, and osteocyte cell lines, suggesting that serotonin may be an important regulatory agent in bone. While no formal recommendations regarding the use of selective serotonin reuptake inhibitors in risk populations are available, caution is advised in individuals with potential risk (i.e., those with osteoporosis or histories of osteoporotic fractures).
选择性5-羟色胺再摄取抑制剂是全球广泛使用的抗抑郁药，具有广泛的临床适应症。尽管总体副作用较小，但我们对19项研究、1篇综述和1项荟萃分析的审查表明，这些独特的抗抑郁药似乎对骨骼有负面影响，特别是在骨矿物质密度和骨折风险方面。更多的5-羟色胺能药物和/或更长时间使用选择性5-羟色胺再摄取抑制剂可能会增加这些风险。由于现有研究中存在众多潜在的混杂因素，这种关系的程度难以确定，但所有研究都表明存在风险。为这些发现提供的额外支持是，在破骨细胞、成骨细胞和骨细胞系上已鉴定出5-羟色胺受体，这表明5-羟色胺可能是骨骼中的一种重要调节因子。虽然目前尚无关于在风险人群中使用选择性5-羟色胺再摄取抑制剂的正式建议，但对于有潜在风险的个体（即患有骨质疏松症或有骨质疏松性骨折病史的个体），建议谨慎使用。
