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. 2018 Sep;103(3):278-288.
doi: 10.1007/s00223-018-0427-z. Epub 2018 May 5.

Normal Bone Microstructure and Density But Worse Physical Function in Older Women Treated With Selective Serotonin Reuptake Inhibitors, a Cross-Sectional Population-Based Study

Free PMC article

Normal Bone Microstructure and Density But Worse Physical Function in Older Women Treated With Selective Serotonin Reuptake Inhibitors, a Cross-Sectional Population-Based Study

Berit Larsson et al. Calcif Tissue Int. .
Free PMC article


Depression in the elderly is today often treated with selective serotonin reuptake inhibitors (SSRIs) because of their favorable adverse effect profile. However, treatment with SSRIs is associated with increased risk of fractures. Whether this increased risk depends on reduced bone strength or increased fall risk due to reduced physical function is not certain. The aim was therefore to investigate if treatment with SSRIs is associated with impaired bone microstructure, bone density, or physical function in older women. From an ongoing population-based study, 1057 women (77.7 ± 1.5 years) were included. Validated questionnaires were used to assess information regarding medical history, medications, smoking, mental and physical health, and physical activity. Physical function was measured using clinically used tests: timed up and go, walking speed, grip strength, chair stand test, and one leg standing. Bone mineral density (BMD) was measured at the hip and spine with dual-energy X-ray absorptiometry (Hologic Discovery A). Bone geometry and microstructure were measured at the ultradistal and distal (14%) site of radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT; XtremeCT). Treatment with SSRIs was associated with higher BMD at the femoral neck, total hip, and lumbar spine, whereas no associations were found for any HR-pQCT-derived measurements. The use of SSRIs was associated with lower grip strength, walking speed, and fewer chair stand rises. These associations were valid also after adjustments for known risk factors for falls. Treatment with SSRIs was, independently of covariates, associated with worse physical function without any signs of inferior bone geometry and microstructure.

Keywords: Bone microstructure; Fall-related injury; Osteoporotic fracture; Physical function; SSRI.

Conflict of interest statement

Conflict of interest

Berit Larsson, Dan Mellström, Lisa Johansson, Anna G. Nilsson, and Daniel Sundh declare that they have no conflicts of interest. Mattias Lorentzon has received lecture or consulting fees from Amgen, Lilly, Meda, UCB Pharma, Renapharma, Radius Health, and Consilient Health. The authors have full control of all primary data and the journal may review all data upon request.

Ethical Approval

All study subjects have given their informed consent and the study protocol was approved by the Ethical Review Board at the University of Gothenburg.

Human and Animal Rights and Informed Consent

This study was conducted according to ethical standards on human subjects of the Institution of Medicine, Department of Geriatric Medicine, University of Gothenburg.

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    1. Borgstrom F, Sobocki P, Strom O, Jonsson B. The societal burden of osteoporosis in Sweden. Bone. 2007;40:1602–1609. doi: 10.1016/j.bone.2007.02.027. - DOI - PubMed
    1. Kanis J, Oden A, Johnell O. Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke. 2001;32:702–706. doi: 10.1161/01.STR.32.3.702. - DOI - PubMed
    1. Cummings SR, Kelsey JL, Nevitt MC, O’Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178–208. doi: 10.1093/oxfordjournals.epirev.a036281. - DOI - PubMed
    1. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254–1259. doi: 10.1136/bmj.312.7041.1254. - DOI - PMC - PubMed
    1. Cumming RG, Kelsey JL, Nevitt MC. Methodologic issues in the study of frequent and recurrent health problems: falls in the elderly. Ann Epidemiol. 1990;1:49–56. doi: 10.1016/1047-2797(90)90018-N. - DOI - PubMed

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