Health & Fitness

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Q) Can anti-depressants hurt my bones?

A) There have been a number of studies over the years that have linked so-called psychotropic drugs to an increased risk of a low bone mineral density (BMD) and therefore an increased chance of osteoporosis and a fracture.  

A recent study of more than 31,000 patients in Manitoba has unfortunately further validated these earlier findings. 

The raw data from the study indicates that the class of drugs know as SSRIs (paroxetine, sertraline, citalopram, escitalopram, fluoxetine, etc.) increases the risk of a low BMD by 40 per cent; anti-convulsants (carbamazepine, lamotrigine, etc.), which are used to help stabilize mood, increase the risk by 35 per cent; and benzodiazepines (lorazepam, clonazepam, oxazepam, etc..) increase the risk by 10 per cent.  

Experts speculate that SSRIs negatively impact bone health by altering the body’s serotonin levels which subsequently affects the activity of the cells that constantly remove old bone and rebuild new bone.     

These results are even more distressing because it has been well-established that patients suffering from psychiatric disorders already have an increased risk of osteoporosis due to many factors including a lack of physical activity, low vitamin D levels and high alcohol use, among many others.  

Of interest was the fact that another class of psychotropic drugs, known as the tricyclic anti-depressants (amitriptyline, nortriptyline. etc.), reduced the risk of a low BMD by 37 per cent. However, the use of these drugs is limited by their potential for sedation and the relatively high risk of side effects they carry in the senior population when used in the high doses required to treat depression.  

Experts suggest that while there is reason to be concerned about bone health in people taking these medications, the risks of untreated psychiatric conditions far outweigh this. 

The take-home message seems to be that physicians and the individuals taking these drugs need to ensure the patients are receiving adequate amounts of calcium in their diet, engaging in regular weight-bearing exercise, making sure they are not vitamin D deficient and having their bone density monitored when deemed appropriate. 

With these sorts of lifestyle changes the vast majority of patients can be safely maintained on these drugs, if required, without unduly increasing their risk of being diagnosed with osteoporosis.

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Monday, May 31, 2010