Mercer's Institute for Successful Ageing, 58024St James's Hospital, Dublin, Ireland.
Jonathan Swift Clinic, 58024St James's Hospital, Dublin, Ireland.
J Geriatr Psychiatry Neurol. 2020 Nov;33(6):340-352. doi: 10.1177/0891988719882091. Epub 2019 Oct 30.
Osteoporotic fractures are associated with major morbidity and mortality, particularly among older age groups. In recent decades, selective serotonin reuptake inhibitors (SSRI) antidepressants have been linked to reduced bone mineral density and increased risk of fragility fracture. However, up to one-third of antidepressant prescriptions are for classes other than SSRIs. Older patients, who are particularly vulnerable to osteoporosis and its clinical and psychosocial consequences, may be prescribed non-SSRI antidepressants preferentially because of increasing awareness of the risks SSRIs pose to bone health. However, to date, the skeletal effects of non-SSRI antidepressants have not been comprehensively reviewed. In this article, we collate and review the available data and discuss the findings. Based on the current literature, we tentatively suggest that tricyclic antidepressants may increase the risk of fracture via mechanisms other than a direct effect on bone mineral density. The risk is apparently confined to current users only and is greatest in the earliest stage of treatment, diminishing thereafter. There is, as yet, insufficient data to conclusively determine the effects of other antidepressant classes on bone. Judicious prescribing of antidepressants among higher risk groups necessitates a thorough review of the individual's risk factors for osteoporosis as well as attention to their falls risk. Further longitudinal, rigorously controlled studies are needed to answer some of the remaining questions on the effects of non-SSRI antidepressants on bone and the mechanisms by which they are exerted.
骨质疏松性骨折与主要的发病率和死亡率相关，尤其是在老年人群中。近几十年来，选择性 5-羟色胺再摄取抑制剂（SSRIs）抗抑郁药与骨密度降低和脆性骨折风险增加有关。然而，多达三分之一的抗抑郁药处方开的并非 SSRIs。由于越来越意识到 SSRIs 对骨骼健康的风险，年龄较大的患者（他们特别容易受到骨质疏松症及其临床和心理社会后果的影响）可能更倾向于开非 SSRIs 类抗抑郁药。然而，迄今为止，非 SSRIs 类抗抑郁药对骨骼的影响尚未得到全面审查。在本文中，我们对现有数据进行了整理和综述，并讨论了研究结果。根据目前的文献，我们初步认为三环类抗抑郁药可能通过除了直接影响骨密度之外的机制增加骨折风险。这种风险显然只限于当前使用者，而且在治疗的早期阶段最大，此后逐渐减少。目前还没有足够的数据可以明确确定其他抗抑郁药类别对骨骼的影响。在高风险人群中谨慎开具抗抑郁药处方时，需要彻底审查患者的骨质疏松症风险因素，并注意其跌倒风险。需要进一步进行纵向、严格控制的研究，以回答关于非 SSRIs 类抗抑郁药对骨骼的影响及其作用机制的一些剩余问题。
