Depression, Antidepressants, and Bone Health in Older Adults: A Systematic Review

Authors

  • Marie Anne Gebara MD,

    Corresponding author
    1. Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri
    • Address correspondence to Marie Anne Gebara, Department of Psychiatry, Washington University in St. Louis, 660 S. Euclid, Box 8134, St. Louis, MO 63110. E-mail: gebaram@psychiatry.wustl.edu

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  • Marcie L. O. Shea MD,

    1. Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri
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  • Kim L. Lipsey MLS,

    1. Department of Bernard Becker Medical Library, School of Medicine, Washington University, St. Louis, Missouri
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  • Steven L. Teitelbaum MD,

    1. Department of Pathology, School of Medicine, Washington University, St. Louis, Missouri
    2. Department of Internal Medicine, School of Medicine, Washington University, St. Louis, Missouri
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  • Roberto Civitelli MD,

    1. Department of Internal Medicine, School of Medicine, Washington University, St. Louis, Missouri
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  • Daniel J. Müller MD, PhD,

    1. Centre for Addiction and Mental Health, Toronto, Ontario, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    3. Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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  • Charles F. Reynolds III MD,

    1. Department of Psychiatry, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
    2. Department of Psychiatry Behavioral and Community Health Sciences, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Benoit H. Mulsant MD,

    1. Centre for Addiction and Mental Health, Toronto, Ontario, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • Eric J. Lenze MD

    1. Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri
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Abstract

Objectives

To examine the association between depression, antidepressant use, and bone health in older adults and the implications for treatment.

Design

Systematic review.

Setting

All studies that measured depression or antidepressant exposure and bone mineral density (BMD).

Participants

Adults aged 60 and older.

Measurements

Age, site of BMD measurement using dual-energy X-ray absorptiometry (DXA), measure of depression or depressive symptoms, association between BMD changes, and depression or antidepressant use.

Results

Nineteen observational studies met the final inclusion criteria; no experimental studies were found. Several cross-sectional and longitudinal studies found that depression or depressive symptoms were associated with a decrease in BMD. Few studies and only two longitudinal studies addressed the association between serotonin reuptake inhibitor (SRI) antidepressant use and a decrease in BMD and they had conflicting results.

Conclusion

Depression and depressive symptoms are associated with low bone mass and accelerated bone loss in older adults; putative mechanisms underlying this relationship are discussed. There is insufficient evidence that SRI antidepressants adversely affect bone health. Thus, a change in current recommendations for the use of antidepressants in older adults is not justified at the present time. Given the high public health significance of this question, more studies are required to determine whether (and in whom) antidepressants may be deleterious for bone health.

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