Monday, January 22, 2007

SSRIs and Osteoporosis

Fresh from the Archives of Internal Medicine, a study by Richards and colleagues has indicated that daily SSRI usage is associated with an increased risk of falling and lower bone density, among others. Here are the results as stated in the abstract (I’ve not read the full study):

Daily SSRI use was reported by 137 subjects. After adjustment for many potential covariates, daily SSRI use was associated with substantially increased risk of incident clinical fragility fracture (hazard rate, 2.1; 95% confidence interval, 1.3-3.4). Daily SSRI use was also associated with increased odds of falling (odds ratio, 2.2; 95% confidence interval, 1.4-3.5), lower bone mineral density at the hip, and a trend toward lower bone mineral density at the spine. These effects were dose dependent and were similar for those who reported taking SSRIs at baseline and at 5 years' follow-up.
Significant sexual side effects, suicide (here and here) and now this? It’s not adding up very nicely for SSRIs. If you are at risk for bone problems, may I suggest Actonel? With such strong research backing it, you can’t beat Actonel for your osteoporosis-related needs (as you can see here and here).

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1 comment:

  1. AnonymousTuesday, January 23, 2007 2:28:00 AM

    I am, by no means, averse to a critical look at the SSRIs.

    And yet, try as I might, I do not understand how the authors can write: "After adjustment for many potential covariates, daily SSRI use was associated with substantially increased risk of incident clinical fragility fracture (hazard rate, 2.1; 95% confidence interval, 1.3-3.4). Daily SSRI use was also associated with increased odds of falling (odds ratio, 2.2; 95% confidence interval, 1.4-3.5), lower bone mineral density at the hip, and a trend toward lower bone mineral density at the spine."

    By my lights, anyone with a serious case of depression in that time period would have been on SSRIs. The tricyclics and other exotic treatments could only be prescribed in "treatment-resistant" depression.

    If everyone with fairly serious cases of depression was put on the SSRIs, how can they control for the effects of depression compared to the effects of the SSRIs? The only way to get solid data, would be to take patients with major depression, and deny them any treatment for years at a time. The likelihood of this happening is remote.

    The cardinal, in fact the only rigorously documented, chemical imbalance associated with serious depression is a disturbance of the endocrine system which does lower calcium levels.

    How do the authors explain that "These effects were dose dependent and were similar for those who reported taking SSRIs at baseline and at 5 years' follow-up?"

    If the SSRIs were indeed the cause, and not a correlate, of the treatment, it would stand to reason that the longer people were on SSRIs, the weaker their bones became. How do the authors reconcile the fact that this is not a progressive phenomenon with their theories?

    As for the correlation between the SSRI dosage and the degree of osteoporosis, two possible explanations are that the more depressed a patient is, the greater the SSRI dosage he or she will be prescribed, either because it a) works, or b) because doctors reflexively adjust their dosing to the severity of the depression.

    Color me deeply skeptical.

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