Two cohort studies — one in older women and the other in older men — find increased bone loss associated with SSRI use.

The studies, published in Archives of Internal Medicine , included some 2700 women and 6000 men followed prospectively in population-based studies of osteoporosis. Participants had their medications inventoried and their BMD measured. The women underwent two measurements of BMD, done roughly 5 years apart; the men had a single measurement.

In women, bone loss decreased faster in those receiving SSRIs than in those receiving either tricyclic or no antidepressants. In men, the bone effect of SSRI use was "similar to that for glucocorticoids."

An editorialist says that a mouse model showing "a reduction in bone mass when serotonin is overexpressed provides biological plausibility." While acknowledging the studies' limitations, he concludes that "depression and ... SSRI use should be added to the list of risk factors that prompt clinicians to more carefully consider bone health."