Antidepressant medications and osteoporosis.
Antidepressant medications and osteoporosis.
复制标题
DOI：
10.1016/j.bone.2012.05.018
复制
发表时间：
2012-09-01
期刊：
影响因子：
4.1
通讯作者：
Vestergaard, P
中科院分区：
文献类型：
--
作者：
Rizzoli, R;Cooper, C;Vestergaard, P
使用作用于5-羟色胺系统的抗抑郁药物与对骨矿物质密度（BMD）的有害影响和骨质疏松症有关。本文回顾了目前的证据，这种影响，并确定未来的研究主题。血清素受体存在于所有主要类型的骨细胞（成骨细胞、骨细胞和破骨细胞）中，表明神经内分泌系统在骨中的重要作用。观察性研究表明抑郁症、抗抑郁药和骨折之间存在复杂的关系。首先，抑郁症本身的存在会增加骨折的风险，这与BMD降低和福尔斯增加有关。抑郁症的一系列方面可能起作用，包括行为因素（例如，吸烟和营养）、生物学变化和混杂因素（例如，合并症和合并用药）。很大一部分抑郁症患者接受抗抑郁药，主要是选择性5-羟色胺再摄取抑制剂（SSRIs）。其中一些与BMD降低（SSRIs）和骨折风险增加（SSRIs和三环药物）有关。目前使用SSRIs和三环类药物的骨折风险比不使用者增加两倍，即使在调整潜在混杂因素后也是如此。虽然SSRIs存在剂量-反应关系，但在整个药物类别中的效果似乎并不均匀，可能与5-羟色胺转运系统的亲和力有关。风险的增加在治疗的早期阶段是最大的，在开始后急剧增加，三环类药物在1个月内达到峰值，SSRIs在8个月内达到峰值。治疗相关风险增加在停药后一年内降低至基线水平。大量证据表明，SSRIs应该被列入骨质疏松性骨折风险因素的药物清单中。
Use of antidepressant medications that act on the serotonin system has been linked to detrimental impacts on bone mineral density (BMD), and to osteoporosis. This article reviews current evidence for such effects, and identifies themes for future research. Serotonin receptors are found in all major types of bone cell (osteoblasts, osteocytes, and osteoclasts), indicating an important role of the neuroendocrine system in bone. Observational studies indicate a complex relationship between depression, antidepressants, and fracture. First, the presence of depression itself increases fracture risk, in relation with decreased BMD and an increase in falls. A range of aspects of depression may operate, including behavioral factors (e.g., smoking and nutrition), biological changes, and confounders (e.g., comorbidities and concomitant medications). A substantial proportion of depressed patients receive antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). Some of these have been linked to decreased BMD (SSRIs) and increased fracture risk (SSRIs and tricyclic agents). Current use of SSRIs and tricyclics increases fracture risk by as much as twofold versus nonusers, even after adjustment for potential confounders. While there is a dose-response relationship for SSRIs, the effect does not appear to be homogeneous across the whole class of drugs and may be linked to affinity for the serotonin transporter system. The increase in risk is the greatest in the early stages of treatment, with a dramatic increase after initiation, reaching a peak within 1 month for tricyclics and 8 months for SSRIs. Treatment-associated increased risk diminishes towards baseline in the year following discontinuation. The body of evidence suggests that SSRIs should be considered in the list of medications that are risk factors for osteoporotic fractures.