Feuer Alexis J, Demmer Ryan T, Thai Ashley, Vogiatzi Maria G
New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.
Bone. 2015 Sep;78:28-33. doi: 10.1016/j.bone.2015.04.042. Epub 2015 May 2.
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed medications to treat depression and anxiety. SSRIs exert their effects by inhibiting the serotonin transporter and modulating extracellular serotonin levels, a neurotransmitter that has been shown to affect bone metabolism in animals. Studies in adults suggest a negative association between SSRI use and bone mineral density (BMD), greater rates of bone loss with SSRI use and increased risk of fractures. However, the results on bone mass have been inconsistent. Furthermore, there is a dearth of studies examining an association between SSRI use and bone mass in the pediatric and adolescent age group.
To investigate associations between SSRI use and bone mass in adolescents.
Cross-sectional analysis of data from the 2005-2010 National Health and Nutrition Examination Study (NHANES).
4303 NHANES participants aged 12-20 years. The mean age was 15.65±2.42 years.
Total femur, femoral neck and lumbar spine bone mineral content (BMC) and BMD assessed via dual-energy X-ray absorptiometry (DXA).
62 out of 4303 subjects used SSRIs. SSRI use was an independent predictor of bone mass after adjusting for age, gender, height and weight Z score, socioeconomic status, physical activity, serum cotinine level and race/ethnicity. After multivariable adjustment, total femur BMC was 8.8% lower among SSRI users versus non-users (mean difference 2.98 g, SE±0.105 g, p=0.0006), while total femur BMD was 6.1% lower (mean difference 0.06 g/cm2, SE±0.002 g/cm2, p=0.016). Femoral neck BMC and BMD and lumbar spine BMC were similarly negatively associated with SSRI use. Compared to nonusers, lumbar spine BMC was 7% lower among SSRI users (mean difference 0.97 g, SE±0.048g, p=0.02) and BMD was 3.2% lower (mean difference 0.03 g/cm2, SE±0.015 g/cm2, p=0.09). Sub-analysis of those individuals treated for more than 6 months yield similar results. Finally, the association of SSRIs with bone mass persisted after excluding individuals with Body Mass Index (BMI) less than 5th percentile thus accounting for the possible confounding effect of anorexia nervosa, which can be treated with SSRIs.
In this NHANES study, adolescents treated with SSRIs had lower DXA measurements of the total femur and lumbar spine compared to SSRI non-users. These findings support the need for future prospective studies to examine the effects of SSRI use on bone mass in adolescents.
选择性5-羟色胺再摄取抑制剂（SSRI）是常用于治疗抑郁症和焦虑症的药物。SSRI通过抑制5-羟色胺转运体并调节细胞外5-羟色胺水平发挥作用，5-羟色胺是一种已被证明会影响动物骨骼代谢的神经递质。针对成年人的研究表明，使用SSRI与骨矿物质密度（BMD）之间存在负相关，使用SSRI时骨量流失率更高且骨折风险增加。然而，关于骨量的研究结果并不一致。此外，在儿科和青少年年龄组中，研究使用SSRI与骨量之间关联的研究较少。
研究青少年使用SSRI与骨量之间的关联。
对2005 - 2010年国家健康与营养检查调查（NHANES）的数据进行横断面分析。
4303名年龄在12 - 20岁的NHANES参与者。平均年龄为15.65±2.42岁。
通过双能X线吸收法（DXA）评估的股骨、股骨颈和腰椎的骨矿物质含量（BMC）和BMD。
4303名受试者中有62人使用了SSRI。在调整年龄、性别、身高和体重Z评分、社会经济地位、身体活动、血清可替宁水平和种族/民族后，使用SSRI是骨量的独立预测因素。经过多变量调整后，使用SSRI者的股骨总BMC比未使用者低8.8%（平均差异2.98 g，标准误±0.105 g，p = 0.0006），而股骨总BMD低6.1%（平均差异0.06 g/cm²，标准误±0.002 g/cm²，p = 0.016）。股骨颈BMC和BMD以及腰椎BMC与使用SSRI同样呈负相关。与未使用者相比，使用SSRI者的腰椎BMC低7%（平均差异0.97 g，标准误±0.048 g，p = 0.02），BMD低3.2%（平均差异0.03 g/cm²，标准误±0.015 g/cm²，p = 0.09）。对治疗超过6个月的个体进行亚分析得出了类似结果。最后，在排除体重指数（BMI）低于第5百分位数的个体后，SSRI与骨量的关联仍然存在，从而排除了神经性厌食症可能的混杂效应，神经性厌食症可用SSRI治疗。
在这项NHANES研究中，与未使用SSRI的青少年相比，使用SSRI治疗的青少年股骨和腰椎的DXA测量值较低。这些发现支持未来需要进行前瞻性研究，以检查使用SSRI对青少年骨量的影响。
