Objective
Mood disorders and antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs) have been associated with lower bone mineral density (BMD) and increased fracture risk. This study aims to assess if trabecular bone score (TBS), a tool for indirectly assessing bone microarchitecture at the lumbar spine, is similarly associated with SSRIs, antidepressants, and current mood disorders.
Methods
This study included 682 women (aged 28-94yr) enrolled in the Geelong Osteoporosis Study. TBS was determined from lumbar spine DXA scans (Lunar Prodigy) using TBS iNsight software (Version 2.2). Current use of antidepressant medications were self-reported. Current mood disorder was determined using the Structured Clinical Interview for Diagnosis (SCID-I/NP). Multivariable linear regression models were used to assess associations between mood disorders, antidepressants and TBS, adjusting for potential covariates including age, height, weight and lifestyle factors (alcohol consumption, physical activity, smoking and other medication use).
Results
Sixty women (9%) met criteria for a current mood disorder and 111 (16%) reported current antidepressant use, of which 84 (12%) were using an SSRI. Current mood disorder was associated with lower TBS, before (p=0.055) and after adjustments for age and height (p<0.001). Similarly, use of any antidepressant and SSRIs were associated with 5.4% and 5.1% lower TBS (both p<0.001), respectively, which persisted in the adjusted models. A combined model including current mood disorder and use of antidepressants found their effects on TBS to be independent (β=-0.048, p=0.009 and β=-0.038, p=0.008 respectively).
Conclusion
Both current mood disorder and antidepressant use were independently associated with lower TBS in a population-based sample of Australian women. This confirms the previous research showing their negative effects on bone health, and presents new data indicating that bone microarchitecture, not just bone quantity, is affected.