Selective serotonin reuptake inhibitors and bone health

Studies demonstrating lower bone mineral density among depressed patients have led to the investigation of antidepressant medications and bone health. It remains unclear whether the depressed state itself or antidepressant treatment is responsible for these findings. Several recent observations support a role for serotonin in bone health. Serotonin transporters have been documented in osteocytes, osteoblasts and osteoclasts. Mice with disruption of the serotonin transporter gene have an osteopenic phenotype. Cohort studies in humans have demonstrated lower bone mineral density, higher rates of bone loss and fracture among those using selective serotonin-reuptake inhibitors compared with those on other antidepressants (primarily tricyclic antidepressants) and those on no antidepressant medication. Areas of future research may include clarifying the role of depression and antidepressant therapy (and the interaction between the two) on bone health, determining potential sources for serotonin in bone cells, identifying mechanisms to explain the impact of serotonin on bone and understanding how serotonin-transporter genetics impact bone.