TOPLINE:

Use of psychotropic medications, particularly selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants, was associated with bone loss at the spine and hip in men with lower BMI, a new cohort study showed. These associations persisted even after adjusting for factors such as socioeconomic status, lifestyle factors, and medications known to affect bone health.

METHODOLOGY:

• A population-based longitudinal cohort study included data from the Geelong Osteoporosis Study for 940 men aged 20 years or older with bone mineral density (BMD) measurements at two or more timepoints between 2001 and 2006. All were followed up for a median of 13.2 years.
• Overall, 6% of the men used a psychotropic medication at baseline, and 14.7% of all participants used one at least once within a median of 45 months. Types of psychotropics used included antidepressants, SSRIs, antipsychotics, and anticonvulsants.
• BMD at the lumbar spine and total hip was measured using dual-energy x-ray absorptiometry at baseline, 5 years, and 15 years. Mood and anxiety disorders were assessed through clinical interviews.
• The primary outcome was the association between psychotropic medication use and bone loss in men over time, with additional analyses evaluating whether BMI modified this association. All analyses were adjusted for age, BMI, smoking, alcohol intake, physical activity, bone-active medications, socioeconomic status, and mood and anxiety disorders.

TAKEAWAY:

• Psychotropic use was associated with greater reductions in lumbar spine BMD (unadjusted mean difference [MD], -0.063 g/cm²; P < .001) and total hip BMD (unadjusted MD, -0.038 g/cm²; P < .001) over the study period. After adjusting for confounders, psychotropic use remained associated with lower BMD at the spine (adjusted MD [aMD], -0.044 g/cm²; P = .02) and hip (aMD, -0.031 g/cm²; P = .005).
• BMI significantly modified the association between psychotropic use and bone loss. Psychotropic use was associated with reduced spine and hip BMD at the 25th BMI percentile (aMD, -0.077 g/cm²; P = .001 and -0.058 g/cm²; P < .001, respectively) and the 50th percentile (aMDs, -0.053 g/cm²; P = .003 and -0.038 g/cm²; P < .001) but not at the 75th percentile.
• Antidepressants were linked to lower lumbar spine BMD in the unadjusted (-0.056 g/cm²; P = .002) and age- and BMI-adjusted (-0.062 g/cm²; P < .001) models, but the association was not significant after full adjustment (-0.032 g/cm²). Similarly, SSRI use was linked to reduced spine BMD in the unadjusted (-0.051 g/cm²; P = .02) and age- and BMI-adjusted (-0.054 g/cm²; P = .01) analyses, with no significant association after full adjustment.
• Anticonvulsants were associated with reduced total hip BMD even after full adjustment (-0.071 g/cm²; P < .001), whereas antipsychotics were not associated with significant changes in lumbar spine or hip BMD in unadjusted or adjusted analyses.

IN PRACTICE:

“Over time, even modest reductions in BMD can be clinically meaningful,” the investigators wrote.

“Given that mental health treatments are often lifelong, this information is important in personalized treatment decisions, especially to manage bone health in psychiatric patients,” they added.

SOURCE:

The study was led by D. Kavindi Weerasinghe, PhD, Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia. It was published online on March 11 in BJPsych Open.

LIMITATIONS:

Data on weight-bearing exercise were not available, possibly affecting the assessments of bone strength and skeletal health. Serum levels of vitamin D, parathyroid hormone, and testosterone were also not available for all participants at each visit. Additionally, the findings were based solely on men, most of whom were White individuals and residing in South-East Australia, possibly limiting generalizability to populations of different ethnicities or regions. Limited statistical power also restricted the analyses of certain psychotropic medication subgroups, including antipsychotics, as well as specific agents and doses.

DISCLOSURES:

The Geelong Osteoporosis Study was funded by the National Health and Medical Research Council. The investigators reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.