FUNPRAM

If you're a middle-aged woman, boosting your mood could cost you your bones.

In a recent observational study, researchers found that women aged 40 to 64 who took antidepressants—specifically selective serotonin reuptake inhibitors (SSRIs)—to cool off the hot flashes and night sweats of perimenopause were up to 76% more likely to break a bone. (Check out these ways to help make menopause less miserable.)

"Elevated fracture risk can be observed after just six months on the antidepressants and stays stably elevated for the next five 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 two years and 67% after five years.

For this study, published in the journal Injury Prevention, Sheu and her 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 five-year period to 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 those who were treated with indigestion drugs," Sheu says.

It's well established that fracture risk is higher among SSRI users with mental disorders such as depression, which is why Sheu and her 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—in the absence of psychiatric conditions—would also weaken bones.

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." She 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," she explains.

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 U.S., thanks to growing use for non-psychiatric disorders, including menopausal symptoms, irritable bowel syndrome, and premature ejaculation.

Sheu and her team are not sure that's such a great idea. In their study, they recommend preventative 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 six 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, she 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."  

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.