Division of Endocrinology, Columbia University Irving Medical Center, New York, NY 10032, United States of America.
Division of Endocrinology, Columbia University Irving Medical Center, New York, NY 10032, United States of America.
Bone. 2020 Nov;140:115552. doi: 10.1016/j.bone.2020.115552. Epub 2020 Jul 27.
Anti-depressants, particularly selective serotonin reuptake inhibitors (SSRIs), are associated with an increased risk of fracture. The mechanism is unclear and may be due to effects on bone metabolism, muscle strength, falls or other factors. It is unknown if serotonin norepinephrine reuptake inhibitors (SNRIs) have similar effects.
We compared musculoskeletal health in current female anti-depressant users and non-users from a population-based multiethnic (35.6% black, 22.3% white and 42.1% mixed) cohort study of adults ≥65 years old in New York (N = 195) using dual x-ray absorptiometry (DXA), trabecular bone score (TBS), vertebral fracture assessment (VFA), high resolution peripheral quantitative computed tomography (HR-pQCT), body composition, and grip strength.
Current anti-depressant users were more likely to be white than non-white (OR 1.9, 95% CI 1.2-2.9) and were shorter than non-users, but there were no differences in age, weight, BMI, physical activity, calcium/vitamin D intake, falls or self-rated health. There were more pelvic fractures in current vs. non-users (7.1% vs. 0%, p = 0.04). Age- and weight-adjusted T-score by DXA was lower in current users at the 1/3-radius (-1.6 ± 1.1 vs. -1.0 ± 1.4, p = 0.04) site only. There was no difference in TBS, vertebral fractures or fat/lean mass by DXA. Age- and weight-adjusted grip strength was 13.3% lower in current users vs. non-users (p = 0.04). By HR-pQCT, age- and weight-adjusted cortical volumetric BMD (Ct. vBMD) was 4.8% lower in users vs. non-users at the 4% radius site (p = 0.007). A similar cortical pattern was seen at the proximal (30%) tibia. When assessed by anti-depressant class, deteriorated cortical microstructure was present only in SSRI users at the radius and only in SNRI users at the proximal tibia.
Anti-depressant use is associated with cortical deterioration and reduced physical function, but effects may be class-specific. These findings provide insight into the mechanism by which anti-depressants may contribute to the increased fracture risk in older women.
抗抑郁药，特别是选择性 5-羟色胺再摄取抑制剂（SSRIs），与骨折风险增加有关。其机制尚不清楚，可能与骨代谢、肌肉力量、跌倒或其他因素有关。目前尚不清楚 5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）是否有类似的作用。
我们使用双能 X 线吸收仪（DXA）、骨小梁评分（TBS）、椎体骨折评估（VFA）、高分辨率外周定量计算机断层扫描（HR-pQCT）、身体成分和握力，比较了纽约（N=195）一项基于人群的多民族（35.6%黑人、22.3%白人、42.1%混血）≥65 岁成年人中当前使用抗抑郁药的女性与非使用者的肌肉骨骼健康状况。
与非使用者相比，当前使用抗抑郁药的患者更有可能是白人（比值比 1.9，95%置信区间 1.2-2.9），且身高较矮，但在年龄、体重、BMI、体力活动、钙/维生素 D 摄入、跌倒或自我报告健康方面无差异。与非使用者相比，当前使用者的骨盆骨折更多（7.1% vs. 0%，p=0.04）。在桡骨 1/3 半径处，经年龄和体重校正后的 DXA 骨密度 T 评分在当前使用者中较低（-1.6±1.1 vs. -1.0±1.4，p=0.04）。TBS、椎体骨折或 DXA 脂肪/瘦体重无差异。当前使用者的握力比非使用者低 13.3%（p=0.04）。通过 HR-pQCT，在桡骨 4%半径处，经年龄和体重校正后的皮质体积 BMD（Ct.vBMD）在使用者中比非使用者低 4.8%（p=0.007）。在胫骨近端（30%）也出现了类似的皮质模式。当按抗抑郁药种类评估时，只有在 SSRI 使用者中，桡骨的皮质微观结构恶化，只有在 SNRI 使用者中，胫骨近端的皮质微观结构恶化。
抗抑郁药的使用与皮质恶化和身体功能下降有关，但可能具有药物特异性。这些发现为抗抑郁药可能导致老年女性骨折风险增加的机制提供了新的见解。
