College of Medicine, Health, Qatar University, P.O. Box 2713, Doha, Qatar.
J Affect Disord. 2025 Jan 15;369:1223-1232. doi: 10.1016/j.jad.2024.10.114. Epub 2024 Oct 28.
Osteoporosis, a significant public health concern, affects millions of adult women globally, leading to increased morbidity and fracture risk. Antidepressant use, prevalent in this demographic, is suggested to influence bone mineral density (BMD), yet evidence remains limited across antidepressant classes.
OBJECTIVE/AIM: We investigated the association between antidepressant use and osteoporosis in a representative sample of adult women in the United States, focusing on different classes of antidepressants and their potential associations with BMD and fracture risk.
We conducted a cross-sectional analysis using data from ten cohorts of the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2000 to 2017-2020. The sample included adult women, with data collected on antidepressant use, BMD scores, and reported fractures. Statistical models adjusted for potential confounders such as Major Depressive Disorder (MDD), age, physical activity, and comorbidities.
Antidepressant use was associated with a 44 % increase in the odds of osteoporosis. Phenylpiperazines showed the highest association, followed by miscellaneous antidepressants and tricyclic antidepressants (TCAs). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) also demonstrated significant, though comparatively lower associations. The odds of fractures were elevated by 62 % among antidepressant users, particularly with phenylpiperazines and miscellaneous antidepressants. A dose-response analysis indicated that both the number and duration of antidepressants were associated with increased odds of osteoporosis.
Our findings underscore the need for heightened awareness of the adverse effects of antidepressants on bone health, particularly in adult women. Careful consideration is necessary when prescribing these medications, especially in populations at risk for osteoporosis and MDD.
骨质疏松症是一个严重的公共卫生问题，影响着全球数以百万计的成年女性，导致发病率和骨折风险增加。在这一人群中，抗抑郁药的使用较为普遍，据推测会影响骨矿物质密度（BMD），但不同抗抑郁药种类的证据仍然有限。
目的/目标：我们在美国成年女性的代表性样本中研究了抗抑郁药使用与骨质疏松症之间的关系，重点关注不同种类的抗抑郁药及其与 BMD 和骨折风险的潜在关联。
我们使用了从 1999 年至 2000 年至 2017 年至 2020 年期间进行的十个全国健康和营养调查（NHANES）队列的数据进行了横断面分析。该样本包括成年女性，收集了抗抑郁药使用、BMD 评分和报告的骨折数据。统计模型调整了可能的混杂因素，如重度抑郁症（MDD）、年龄、身体活动和合并症。
抗抑郁药的使用与骨质疏松症的发生几率增加 44%相关。苯并哌嗪类药物显示出最高的关联，其次是其他类抗抑郁药和三环类抗抑郁药（TCAs）。选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）也显示出显著但相对较低的关联。抗抑郁药使用者骨折的几率增加了 62%，尤其是苯并哌嗪类药物和其他类抗抑郁药。剂量反应分析表明，抗抑郁药的数量和使用时间均与骨质疏松症发生几率的增加相关。
我们的研究结果强调了需要提高对抗抑郁药对骨骼健康的不良影响的认识，尤其是在成年女性中。在开具这些药物时需要谨慎考虑，特别是在骨质疏松症和 MDD 风险较高的人群中。
