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Old 01-23-2007, 05:47 AM   #1
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Exclamation Antidepressants and Fracture Risk

There are many news items today about a new study showing that elderly users of SSRI antidepressants (Prozac, Zoloft, etc.) have:
Increased risk of falls
Twice the risk of bone fractures
Lower BMD (-4% hip, -2.4% spine).

But it's not clear to me that the lower BMD is really caused by the antidepressants, particularly since a study a few months back indicated that Prozac increased BMD in mice.

Since people who are not physically active are more likely to become depressed (and need antidepressants), might the lower BMD really be caused by their lower levels of physical activity, and not by the antidepressants?

 
Old 01-23-2007, 11:29 AM   #2
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Re: Antidepressants and Fracture Risk

It's also possible that the increased risk of falls is due to SSRI's causing dizziness as a side effect.

 
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Old 01-23-2007, 01:24 PM   #3
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Re: Antidepressants and Fracture Risk

PikaB and Piano: I think both of you are correct with this analogy, because I believe that people who are depressed usually don't get as much physical activity as non depressed individuals, and when you don't get sufficient exercise, then you would experience dizziness, which could result in a fall. In this study though they mentioned that they took dizziness, and physical frailty into consideration, and thought that there was some other link to fractures, but then they don't say what that is.

I have heard that depression itself is a contributing factor to low bmd/fractures through the excretion of excess stress hormones, as well as endogenous steriods which occur when someone is depressed.

Whenever I go to see my Osteo dr. one of the first questions they ask when updating the file, is "are you experiencing depression?" After being asked this many times I finally ask why they ask, since it seems unsual to me because none of my other drs ever ask this question, and the nurse said that depression is a major risk factor for bone loss. She continued by telling me that those who respond to the question with a no, invariably have higher bmd and those who say yes are asked if treatment has been considered.

Since drs treat depression with SSRI's maybe it's not the drug, but the disease of depression that is the link to low bmd and fracture, along with the lack of exercise, and physical frailty (dizziness, weakness, low muscle strength etc).


Hopefully this will be figured out with more studies, because for now it seems like blaming SSRI's is not backed up by enough convincing research.

 
Old 01-23-2007, 07:19 PM   #4
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Re: Antidepressants and Fracture Risk

Quote:
Originally Posted by DesertBloom View Post
...In this study though they mentioned that they took dizziness, and physical frailty into consideration, and thought that there was some other link to fractures, but then they don't say what that is.
I found another article, which gives a more thorough review of the study. It says that bone mineral density and falls may be affected adversely by daily SSRI use but that fracture rates remain elevated despite adjustment for these two risk factors. And, depressive symptoms were also unlikely to have been responsible for the link between fracture and SSRIs because the researchers found no association between symptoms and fractures in univariate or multivariate regression models (whatever that means).

So this is indeed troublesome for those of us with osteoporosis who take antidepressants. (I've been on Prozac for four years.)

 
Old 01-23-2007, 07:31 PM   #5
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Re: Antidepressants and Fracture Risk

So between using SSRI's for depression and PPI's for stomach problems - we will have a hard time maintaining or gaining bone density. PPI's draw calcium out of your system and I wonder if the SSRI's do also. What other explanation is there for a higher fracture risk?Anybody know what the regression models mean?

 
Old 01-24-2007, 02:31 AM   #6
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Re: Antidepressants and Fracture Risk

Quote:
Originally Posted by taape View Post
...What other explanation is there for a higher fracture risk?...
One of the articles summarizing the study stated that SSRI use results in boosting serotonin in the brain (and the mood of depressed patients); altering the serotonin's reabsorption in the body also affects bone development by adversely affect osteoblasts, cells that form bone, resulting in more brittle bones.

Waaahhhhhh!

 
Old 01-24-2007, 01:07 PM   #7
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Re: Antidepressants and Fracture Risk

And isn't depression itself a contributing factor toward osteoporosis? I believe I have read that depression is linked to bone loss. So maybe the people who are on SSRIs have more fractures because they have depression, not because of the medications. I don't know....it's so hard to know which studies and which conclusions to believe!

 
Old 01-24-2007, 01:45 PM   #8
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Re: Antidepressants and Fracture Risk

Quote:
Originally Posted by PikaB View Post
...So this is indeed troublesome for those of us with osteoporosis who take antidepressants. (I've been on Prozac for four years.)
PikaB: In those four years, has your bmd gone down? I was also wondering if you are still on forteo? Have you made that bandelero yet ?

If you haven't lost any density and it's gone up (I hope) then I wouldn't think that the Prozac is doing anything detrimental, to your bones, unless the study is saying that this loss of bone occurs over a longer length of time, or has some cumalative affect. If I were you or anyone else taking SSRI, I would worry more about the affects of depression on bone than the med, until they present a better study; for some reason this one isn't making a whole lot of sense to me.

Did they say how this malabsorption of serotonin is adversely affecting the osteoblasts? Isn't there a whole list of other meds/medical conditions that could affect bone resorption if the link is it's affect on the reabsorption of serotonin?

Last edited by DesertBloom; 01-24-2007 at 03:49 PM.

 
Old 01-25-2007, 03:01 AM   #9
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Re: Antidepressants and Fracture Risk

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Originally Posted by DesertBloom View Post
PikaB: In those four years, has your bmd gone down? I was also wondering if you are still on forteo? Have you made that bandelero yet ?
My osteoporosis developed during the time I was on Prozac, so it's reasonable to assume that it is probably a contributing factor. Spine BMD in Jan. 2004 was T=-2.2; in Jan. 2005 was T=-2.65.

I have been on Forteo for 10 months; during that time there has been slight BMD improvement (to T=-2.5) but not as much as I had hoped. It seems possible that the Prozac is reducing the beneficial effect of Forteo. Even worse, I really am troubled by the icky thought that while Forteo is building new bone, the Prozac may be promptly turning that new bone brittle. (In the study, fracture rate among SSRI users was much higher even when BMD was accounted for.) So my current (spur-of-the-moment) plan is to try to eliminate the use of Prozac during the next two months, so that during my second year of Forteo I can hopefully get its full benefit. If severe depression emerges, I'll cross that bridge when I come to it. Right now my bones have priority, since there is such a short window for Forteo use.

(And, I'm still saving my empty Forteo pens, but haven't done anything further toward the bandelero.)

Last edited by PikaB; 01-25-2007 at 04:00 AM.

 
Old 01-25-2007, 10:51 AM   #10
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Re: Antidepressants and Fracture Risk

PikaB: So sorry to hear that... I didn't realize that your bmd was directly related to SSRI, I hope that your plan works and I wish you all the luck in the world. Have you had any bone marker tests done, to give yourself and alternate look at your bone formation/resorption status? Hopefully the next year of forteo will show great improvements!!

Good Luck...

Last edited by DesertBloom; 01-25-2007 at 01:18 PM.

 
Old 01-25-2007, 09:44 PM   #11
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Re: Antidepressants and Fracture Risk

PikaB,
I hope the Forteo does work for you and you can get along with the Prozac. Why are you saving the Forteo pens?

 
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