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Depression, Antidepressants and Bone Health in Older Adults: A Systematic Review

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Depression, Antidepressants and Bone Health in Older Adults: A Systematic Review

Auteurs : Marie Anne Gebara [États-Unis] ; Marcie L. O. Shea [États-Unis] ; Kim L. Lipsey [États-Unis] ; Steven L. Teitelbaum [États-Unis] ; Roberto Civitelli [États-Unis] ; Daniel J. Müller [Canada] ; Charles F. Reynolds ; Benoit H. Mulsant [Canada] ; Eric J. Lenze [États-Unis]

Source :

Journal of the American Geriatrics Society [ 0002-8614 ] ; 2014.

RBID : PMC:4134423

Abstract

Objectives

Some studies have reportedan association between depression or serotonin reuptake inhibitor (SRI) antidepressant use and osteoporosis. This association raises concern about the widespread use of antidepressants in older adults and suggests the need to reevaluate this practice. This review examines the association of both depression and antidepressant use with bone health in older adults and the implications for treatment.

Design

A systematic review of studies of the association between depression or antidepressants and bone health in older adults.

Setting

All studies that measured depression or antidepressant exposure and bone mineral density (BMD).

Participants

Adults aged 60 and above.

Measurements

Age, site of BMD measurement by dual-energy x-ray absorptiometry (DXA), measure of depression or depressive symptoms, association between BMD changes and depression or antidepressant use.

Results

Nineteen observational studies met the final inclusion criteria; no experimental studies were found. Several cross-sectional and longitudinal studies found that depression or depressive symptoms were associated with decreased BMD. Few studies and only two longitudinal studies addressed the association between SRI antidepressant use and a decrease in BMD and they had conflicting results.

Conclusion

Depression and depressive symptoms are associated with decreased bone mass and accelerated bone loss in older adults; putative mechanisms underlying this relationship are discussed. There is insufficient evidence that SRI antidepressants adversely affect bone health.Thus, a change in current recommendations for the use of antidepressants in older adults is not justified at the present time. Given the high public health significance of this question, more studies are required to determine whether (and in whom) antidepressants may be deleterious for bone health.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134423

DOI: 10.1111/jgs.12945
PubMed: 25039259
PubMed Central: 4134423

Affiliations:

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<wicri:noCountry code="subfield">PA.</wicri:noCountry>
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<author><name sortKey="Lenze, Eric J" sort="Lenze, Eric J" uniqKey="Lenze E" first="Eric J." last="Lenze">Eric J. Lenze</name>
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<country xml:lang="fr">États-Unis</country>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title>
<p id="P1">Some studies have reportedan association between depression or serotonin reuptake inhibitor (SRI) antidepressant use and osteoporosis. This association raises concern about the widespread use of antidepressants in older adults and suggests the need to reevaluate this practice. This review examines the association of both depression and antidepressant use with bone health in older adults and the implications for treatment.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">A systematic review of studies of the association between depression or antidepressants and bone health in older adults.</p>
</sec>
<sec id="S3"><title>Setting</title>
<p id="P3">All studies that measured depression or antidepressant exposure and bone mineral density (BMD).</p>
</sec>
<sec id="S4"><title>Participants</title>
<p id="P4">Adults aged 60 and above.</p>
</sec>
<sec id="S5"><title>Measurements</title>
<p id="P5">Age, site of BMD measurement by dual-energy x-ray absorptiometry (DXA), measure of depression or depressive symptoms, association between BMD changes and depression or antidepressant use.</p>
</sec>
<sec id="S6"><title>Results</title>
<p id="P6">Nineteen observational studies met the final inclusion criteria; no experimental studies were found. Several cross-sectional and longitudinal studies found that depression or depressive symptoms were associated with decreased BMD. Few studies and only two longitudinal studies addressed the association between SRI antidepressant use and a decrease in BMD and they had conflicting results.</p>
</sec>
<sec id="S7"><title>Conclusion</title>
<p id="P7">Depression and depressive symptoms are associated with decreased bone mass and accelerated bone loss in older adults; putative mechanisms underlying this relationship are discussed. There is insufficient evidence that SRI antidepressants adversely affect bone health.Thus, a change in current recommendations for the use of antidepressants in older adults is not justified at the present time. Given the high public health significance of this question, more studies are required to determine whether (and in whom) antidepressants may be deleterious for bone health.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <pmc-dir>properties manuscript</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-journal-id">7503062</journal-id>
<journal-id journal-id-type="pubmed-jr-id">4443</journal-id>
<journal-id journal-id-type="nlm-ta">J Am Geriatr Soc</journal-id>
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<article-id pub-id-type="manuscript">NIHMS595157</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Depression, Antidepressants and Bone Health in Older Adults: A Systematic Review</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Gebara</surname>
<given-names>Marie Anne</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Shea</surname>
<given-names>Marcie L.O.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lipsey</surname>
<given-names>Kim L</given-names>
</name>
<degrees>M.L.S</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Teitelbaum</surname>
<given-names>Steven L.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Civitelli</surname>
<given-names>Roberto</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Müller</surname>
<given-names>Daniel J.</given-names>
</name>
<degrees>M.D., Ph.D.</degrees>
<xref ref-type="aff" rid="A5">5</xref>
<xref ref-type="aff" rid="A6">6</xref>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Reynolds</surname>
<given-names>Charles F.</given-names>
<suffix>III</suffix>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A8">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mulsant</surname>
<given-names>Benoit H.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A5">5</xref>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lenze</surname>
<given-names>Eric J.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Department of Psychiatry, Washington University School of Medicine, Washington University, St. Louis, MO</aff>
<aff id="A2"><label>2</label>
Bernard Becker Medical Library, Washington University School of Medicine, Washington University, St. Louis, MO</aff>
<aff id="A3"><label>3</label>
Department of Pathology, Washington University School of Medicine, Washington University, St. Louis, MO</aff>
<aff id="A4"><label>4</label>
Department of Internal Medicine, Washington University School of Medicine, Washington University, St. Louis, MO</aff>
<aff id="A5"><label>5</label>
Centre for Addiction and Mental Health, Toronto, ON</aff>
<aff id="A6"><label>6</label>
Department of Psychiatry, University of Toronto, Toronto, ON</aff>
<aff id="A7"><label>7</label>
Pharmacology & Toxicology, University of Toronto, Toronto, ON</aff>
<aff id="A8"><label>8</label>
Department of Psychiatry and Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA.</aff>
<author-notes><corresp id="CR1"><bold>Corresponding author:</bold>
 Marie Anne Gebara Department of Psychiatry, Washington University in St. Louis, 660 S. Euclid, Box 8134 St. Louis, MO 63110 <email>gebaram@psychiatry.wustl.edu</email>
 Phone : 314 747 5959 Fax : 314 362 4260; <bold>Alternate corresponding author:</bold>
 Eric Lenze <email>lenzee@psychiatry.wustl.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>4</day>
<month>6</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>15</day>
<month>7</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="ppub"><month>8</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>8</month>
<year>2015</year>
</pub-date>
<volume>62</volume>
<issue>8</issue>
<fpage>1434</fpage>
<lpage>1441</lpage>
<pmc-comment>elocation-id from pubmed: 10.1111/jgs.12945</pmc-comment>
      <abstract><sec id="S1"><title>Objectives</title>
<p id="P1">Some studies have reportedan association between depression or serotonin reuptake inhibitor (SRI) antidepressant use and osteoporosis. This association raises concern about the widespread use of antidepressants in older adults and suggests the need to reevaluate this practice. This review examines the association of both depression and antidepressant use with bone health in older adults and the implications for treatment.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">A systematic review of studies of the association between depression or antidepressants and bone health in older adults.</p>
</sec>
<sec id="S3"><title>Setting</title>
<p id="P3">All studies that measured depression or antidepressant exposure and bone mineral density (BMD).</p>
</sec>
<sec id="S4"><title>Participants</title>
<p id="P4">Adults aged 60 and above.</p>
</sec>
<sec id="S5"><title>Measurements</title>
<p id="P5">Age, site of BMD measurement by dual-energy x-ray absorptiometry (DXA), measure of depression or depressive symptoms, association between BMD changes and depression or antidepressant use.</p>
</sec>
<sec id="S6"><title>Results</title>
<p id="P6">Nineteen observational studies met the final inclusion criteria; no experimental studies were found. Several cross-sectional and longitudinal studies found that depression or depressive symptoms were associated with decreased BMD. Few studies and only two longitudinal studies addressed the association between SRI antidepressant use and a decrease in BMD and they had conflicting results.</p>
</sec>
<sec id="S7"><title>Conclusion</title>
<p id="P7">Depression and depressive symptoms are associated with decreased bone mass and accelerated bone loss in older adults; putative mechanisms underlying this relationship are discussed. There is insufficient evidence that SRI antidepressants adversely affect bone health.Thus, a change in current recommendations for the use of antidepressants in older adults is not justified at the present time. Given the high public health significance of this question, more studies are required to determine whether (and in whom) antidepressants may be deleterious for bone health.</p>
</sec>
</abstract>
<kwd-group><kwd>depression</kwd>
<kwd>antidepressants</kwd>
<kwd>BMD</kwd>
<kwd>older adults</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Canada</li>
<li>États-Unis</li>
</country>
<region><li>Missouri (État)</li>
<li>Ontario</li>
</region>
<settlement><li>Toronto</li>
</settlement>
<orgName><li>Université de Toronto</li>
</orgName>
</list>
<tree><noCountry><name sortKey="Reynolds, Charles F" sort="Reynolds, Charles F" uniqKey="Reynolds C" first="Charles F." last="Reynolds">Charles F. Reynolds</name>
</noCountry>
<country name="États-Unis"><region name="Missouri (État)"><name sortKey="Gebara, Marie Anne" sort="Gebara, Marie Anne" uniqKey="Gebara M" first="Marie Anne" last="Gebara">Marie Anne Gebara</name>
</region>
<name sortKey="Civitelli, Roberto" sort="Civitelli, Roberto" uniqKey="Civitelli R" first="Roberto" last="Civitelli">Roberto Civitelli</name>
<name sortKey="Lenze, Eric J" sort="Lenze, Eric J" uniqKey="Lenze E" first="Eric J." last="Lenze">Eric J. Lenze</name>
<name sortKey="Lipsey, Kim L" sort="Lipsey, Kim L" uniqKey="Lipsey K" first="Kim L" last="Lipsey">Kim L. Lipsey</name>
<name sortKey="Shea, Marcie L O" sort="Shea, Marcie L O" uniqKey="Shea M" first="Marcie L. O." last="Shea">Marcie L. O. Shea</name>
<name sortKey="Teitelbaum, Steven L" sort="Teitelbaum, Steven L" uniqKey="Teitelbaum S" first="Steven L." last="Teitelbaum">Steven L. Teitelbaum</name>
<name sortKey="Teitelbaum, Steven L" sort="Teitelbaum, Steven L" uniqKey="Teitelbaum S" first="Steven L." last="Teitelbaum">Steven L. Teitelbaum</name>
</country>
<country name="Canada"><region name="Ontario"><name sortKey="Muller, Daniel J" sort="Muller, Daniel J" uniqKey="Muller D" first="Daniel J." last="Müller">Daniel J. Müller</name>
</region>
<name sortKey="Muller, Daniel J" sort="Muller, Daniel J" uniqKey="Muller D" first="Daniel J." last="Müller">Daniel J. Müller</name>
<name sortKey="Mulsant, Benoit H" sort="Mulsant, Benoit H" uniqKey="Mulsant B" first="Benoit H." last="Mulsant">Benoit H. Mulsant</name>
</country>
</tree>
</affiliations>
</record>

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Depression, Antidepressants and Bone Health in Older Adults: A Systematic Review

Depression, Antidepressants and Bone Health in Older Adults: A Systematic Review

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