“Elevated fracture risk can be observed after just 6 months on the antidepressants and stays stably elevated for the next 5 years,” says lead investigator Yi-han Sheu, MD, a doctoral student in the department of epidemiology at Harvard University’s T.H. Chan School of Public Health. The risk was 73% after 2 years and 67% after 5 years. (Looking for more health tips? Get your FREE trial of Prevention + 12 FREE gifts.) For this study, published in the journal Injury Prevention, Sheu and his team looked at health data from the PharMetrics Claims Database, focusing on some 137,000 women with no mental health issues who started SSRIs between 1998 and 2010. The SSRIs included citalopram, escitalopram, fluoxetine, fluvoxamine paroxetine, and sertraline, better known as Celexa, Paxil, Prozac, and Zoloft. They then compared the bone strength of this group over a 5-year period with that of a control group of 236,000 women of the same age who were taking medication for indigestion. “The risk of fracture among those who took SSRIs was about 1.7 times higher than among those who were treated with indigestion drugs,” Sheu says. MORE: 7 Odd Reasons You Bruise Easily It’s well established that fracture risk is higher among SSRI users with mental disorders such as depression, which is why Sheu and his team purposely looked at women who were taking SSRIs for non-psychiatric reasons—in this case, to manage the vasomotor symptoms of menopause. The goal was to see if taking SSRIs would also weaken bones in the absence of psychiatric conditions. It did. “While we chose middle-aged women who were prone to menopausal symptoms as our population, this effect is not confined to those with menopausal symptoms,” Sheu explains. “The same risk should apply to women in this age range who take SSRIs for any reason.” He adds, “Our study is the first to manifest the same elevated risk in a non-psychiatric population.” It’s not exactly clear why SSRIs damage bones, but based on previous research, Sheu believes that they interrupt the bone-building process. “Bones are constantly getting reabsorbed [breaking down] and rebuilding, and the change in the behavior of serotonin seems to tip the scales toward more breaking down and less rebuilding, which leaves bones weaker and more prone to fracture,” he explains. MORE: The 10 Worst Things That Can Happen When You Don’t Get Enough Vitamin D More women are expected to start taking SSRIs for menopausal symptoms now that the FDA has approved them for that purpose. Antidepressants are already the third most commonly prescribed class of drug in the US, thanks to growing use for non-psychiatric conditions such as menopausal symptoms, irritable bowel syndrome, and premature ejaculation. Sheu and his team are not sure that’s such a great idea. In their study, they recommend preventive measures such as lowering the dosage of SSRIs (to levels below those given to women with mental disorders), and taking the drug for less time, maybe just 6 months—or not at all. “From the perspective of fracture risk, it might make sense to not take the medication at all,” Sheu says. “Nevertheless, all treatments have to be weighed risks against benefits.” Vasomotor symptoms during perimenopause—the hot flashes and night sweats that plague women as their reproductive hormones decline—can be really bothersome, significantly compromising quality of life, he adds. And not everyone is a good candidate for hormone therapy, which is a more effective menopause treatment. “To our knowledge, these are the two kinds of remedies that most effectively treat vasomotor symptoms,” says Sheu. “In short, we have yet to find another substitute for SSRIs in this regard.” MORE: 5 Reasons It Hurts Down There Fortunately, overall fracture rates tend to be low in this age group. But if you’re concerned about bone loss, especially if you have a family history of osteoporosis, be sure to mention it to any doctor who suggests that you take antidepressants, particularly SSRIs. And in the meantime, protect your bones with weight-bearing exercise and adequate amounts of vitamin D and calcium.
