Selective serotonin inhibitors (SSRIs) are assumed to play a role in bone metabolism via the modulation of serotonin levels. Several cross-sectional studies reported an association between SSRI use and lower bone mineral density (BMD). However, longitudinal studies showed conflicting results and had limited longitudinal exposure information. Therefore, our objective was to investigate the association between SSRIs and BMD, and changes in BMD in a longitudinal study with 14 years of follow-up. Our study was embedded in the population-based Rotterdam Study cohort. SSRI use was based on pharmacy dispensing records. Femoral neck BMD was measured using dual-energy X-ray assessment (DXA) at minimal 1 and up to 4 visits between 1991 - 2004. The annual percentage change in BMD was calculated between 2 consecutive visits. Multivariate linear mixed models were applied to examine the association between SSRI use and repeated measurements of BMD, and changes in BMD, stratified by sex, in comparison to non-users. Analyses were adjusted for time-varying covariates; age, body mass index, lower limb disability, smoking, alcohol intake, medication use and depressive symptoms. The study population included 2,568 men and 3,484 women, with in total 14,488 BMD measurements and 7,212 BMD change values. At baseline, the mean age was 68.1 years (standard deviation [SD] 7.7), and 68.9 years (SD 8.3), respectively, with a median of 3.9 years between BMD measurements (interquartile range 1.8 4.6). In women, the mean BMD of SSRI users was 0.840 g/cm2 (n=78), versus 0.831 g/cm2 for non-users (n=6739, p=0.194). The annual decline in BMD in women was not significantly stronger in SSRI users (n=117) than in non-users (N=3086, beta=-0.093%, p=0.152). Similarly, no significant association was observed for men. Therefore, our study indicated that use of SSRIs is not associated with lower BMD, and a stronger decline in BMD in middle-aged and older men and women.
Disclosure: The authors declared no competing interests. This study was funded by the ZonMW (The Dutch Medical Research Agency) Priority Medicines Elderly program [113101002 and 1131101006; non-commercial].