Cross-sectional analysis; Women () with past or current major depression; 24 nondepressed with age-matched controls; n SSRI users/nonusers = 15/33
Structured clinical interview for DSM-III-R 15 (62.5%) of 24 depressed women on SSRIs BMD (g/cm2) of the anteroposterior and lateral lumbar (L1βL4) spine, total hip, and subregions (femoral neck and trochanter) were measured
The mean (SD) bone density in the women with past or current depression was 6.5% lower at the spine, 13.6% lower at the femoral neck, 10.8% lower at the trochanter compared to nondepressed women; but after controlling for BMI, no correlation between BMD and SSRI use
Sampling: small sample of subjects on SSRI therapy Some subjects were on concurrent drug therapy that may have affected the lack of an association between SSRI and BMD No report of dosage or duration of SSRI use
Cross-sectional analysis; Men age 65 enrolled in the MrOS study; SSRI users/nonusers = 160/5835
160 (2.6%) men were on SSRIs BMD (g/cm2) of lumbar spine (L1βL4) and total hip and subregions (femoral neck and trochanter)
SSRI use resulted in 4-5% lower BMD at the hip and 6% lower at the spine
Sample: examined older population and only 10% were of minorities No mention of method of depression diagnosis in subjects No report of dosage or duration of SSRI use
Nested case-control analysis; Premenopausal women (age 21β45 yrs) with MDD; 44 nondepressed women with age matched controls; n SSRI users/nonusers = 54/35
Structured clinical interview for DSM-IV and Global Assessment of Functioning Scale; Hamilton Depression Scale (24 questions) and the Hamilton Anxiety Scale (14 questions) 73 women with MDD were on antidepressants; 54 (61%) on SSRIs BMD (g/cm2) of anteroposterior lumbar (L1βL4) spine, femoral neck, total hip, and mid-distal radius (CV 0.4%)
SSRI use did not result in lower BMD at the hip, spine, or radius after adjustment for BMI
Sample: women with MDD in this cohort had ~5βkg higher BMI and racial homogeneity Most depressed participants on SSRI were in remission No report of dosage or duration of SSRI use
Longitudinal analysis; Women (mean age 78.5 years) enrolled in the SOF study followed for 4.0 years; n SSRI users/nonusers = 198/2524
15-item Geriatric Depression Scale SSRIs 198 (7.2%) total participants, 65 (2%) at baseline, and 178 (6.5%) at followup BMD (g/cm2) of the total hip and 2 sub-regions (femoral neck and trochanter) were measured; (mean Β± SD, 4.9 Β± 0.6 years between examinations)
SSRI use resulted in 1.7β2.6 greater rates of total hip bone loss, femoral neck, trochanterand 4% lower BMD at the hip (spine NS) after adjustment for confounders (0.82% for SSRI users versus 0.47% for nonusers)
Sample: cohort of only elderly women; thus, cannot generalize to other populations No report of dosage or duration of SSRI use
Cross-sectionaland longitudinal analyses; n =5008 Men and women age 50 enrolled in the CaMOS study; SSRI users/nonusers = 137/4871
MCS and MHI-5 ofMedical Outcomes Study 36-Item Short-Form Health Survey questionnaire 137 (2.7%) men were current daily SSRIs users and 609 (12.2%) men reported depressive symptoms BMD (g/cm2) of the lumbar spine (L1βL4) and hip were measured
SSRI users had 4% decrease in BMD at the total hip (% difference between daily SSRI users and nonusers, β4.0 (95% CI, β6.6 to β1.4)) and 2.4% at the lumbar spine (% difference between daily SSRI users and nonusers, β2.4 (95% CI, β5.5 to 0.9))
Sample: cohort of only elderly men and racial homogeneity, thus, cannot extrapolate findings to other populations Subjectsβ depression was not diagnosed by a psychiatrist Duration of daily SSRI use was not reported
Cross-sectional analysis; n =607 Women age 40-65 yrs clinically diagnosed with depression; n SSRI users/nonusers = 26/581
Structured clinical interview for DSM-IV-TR research version, nonpatient edition 26 (20.3%) women were current users of SSRIs BMD (g/cm2) was measured at the posterior-anterior (PA) spine, hip, total body, and forearm
BMD among SSRI users was 5.6% lower at the femoral neck, 6.2% lower at the trochanter and 4.4% lower at the mid-forearm than nonusers after controlling for confounders; no differences in BMD were detected at other sites.
Sample: relatively small number of SSRI users may have limited the power to detect significant differences in BMD, racial homogeneity No report of dosage or duration of SSRI use
Cross-sectional analysis; Premenopausal women with unipolar depression compared with 47 healthy, age-and osteoporosis risk factors-matched premenopausal women; SSRI users/nonusers = 32/41
Structured clinical interview for DSM-IV with at least 2 years of illness duration 32 (43.8%) women were current SSRI users BMD (g/cm2) of the lumbar spine (L1βL4) and femoral neck were measured
BMD of the lumbarspine was 1.8% higher and 1.8% higher at the femoral neck compared SSRI nonusers; thus, BMD at lumbar spine and femoral neck NS
Sample: Absence of naive, untreated depressed women; small sample size No report of dosage or duration of SSRI use
Prospective population-based Cohort study; Men and women age 55 years enrolled in the Rotterdam Study; SSRI users/nonusers = 111/1061
Home interview using Center for Epidemiologic Studies Depression scale (CES-D) Total ; 111 (1.4%) SSRI users and 1061 (13.2%) nonusers BMD (g/cm2) of the femoral neck was measured
BMD of femoral neck of SSRI users was 3-fold lower than SSRI nonusers (95% CI, 1.41β3.59); 2.25-fold risk increase of nonvertebral fracture for SSRI users
Sample: small number of SSRI users Depression diagnosis was not assessed by psychiatrist No report of dosage or duration of SSRI use
SSRI: Selective Serotonin Re-Uptake Inhibitors, CaMOS: Canadian Multicentre Osteoporosis Study, BMD: Bone Mineral Density, SOF: Study of Osteoporosis, OR: Odds Ratio, MDD: Major Depressive Disorder, NS: Not Significant, CI: Confidence Interval, MHI-5: Mental Health Inventory 5, DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorder, MCS: Mental Component Score, HDRS: Hamilton Depression Rating Scale.
