In the United States, more than one in four women take medication to treat mental health conditions. Women ages 45 and older reportedly have the highest rate of antidepressant use in the United States, with the highest increase in recent years among women 65 and older. Although men’s use of antidepressant medications has increased in recent times, it is still only about half that of women’s.

According to Maureen Beurskins, MD, a board-certified gynecologist with Carolinas HealthCare System, many women may develop anxiety or depression or notice a worsening of pre-existing conditions during menopause, as a result of estrogen loss.

“You have to consider that many women are living a third of their lives in menopause,” Dr. Beurskins says. “It would be a huge disservice on the part of health care professionals not to address their mental health complaints.”

The most commonly prescribed antidepressants today are selective serotonin reuptake inhibitors (SSRIs). For women who are not suffering from depression or other mental disorders, SSRIs are also approved by FDA at lowered doses for treating menopausal symptoms such as hot flashes and night sweats. Although these medications are generally considered safe and effective, research is showing that, in some cases, SSRIs may contribute to bone loss in menopausal women.

Bone Health, Bone Loss

Normally, healthy bone tissue continually breaks down and rebuilds in a balanced manner, so that bones stay dense and strong, especially when we are young. As we age, our bones breakdown faster than they can be rebuilt, so they become more porous. For menopausal women, this process speeds up and becomes more serious with the loss of estrogen. Researchers suspect that SSRIs may also shift the balance of bone construction and deconstruction, further reducing bone density and causing bones to become thinner, weaker, and more susceptible to fractures.

Although studies have had mixed results, one group of researchers, from Harvard and Northeastern Universities and UNC Chapel Hill, found that fracture rates in women aged 40 to 64 who were taking SSRIs were up to 76% higher after one year, compared to similar-age women who did not take SSRIs. The medications were studied as a group; individual types of SSRIs were not identified. The researchers suggest that further study is necessary to determine whether shorter treatment times might help reduce the risk.

According to the National Osteoporosis Foundation, 54 million Americans have osteopenia (low bone density) or osteoporosis (weakened, very porous bones) and, as a result, 2 million of them—half of all women and a quarter of all men over the age of 50—will end up with broken bones due to this disease. Bone thinning can occur at any age, however, and other risk factors include not getting enough calcium and vitamin D in your diet, getting too much protein, salt or caffeine in your diet, inactivity, smoking and taking other medication that cause bone loss.

What You Can Do

Yi-Han Sheu, lead author of the Harvard/Northeastern/UNC study, and Ph.D. candidate at Harvard Medical School’s Department of Epidemiology, recommends speaking with your physician about the added risk of fracture if you are over 50 or have a family history of osteoporosis, and you are taking SSRI medication for more than six months.

“At this point, I always discuss the possible link between SSRIs and bone thinning with my patients,” Dr. Beurskins says. “If other risk factors are present, such as smoking or low weight, I might call for a bone density test earlier than the recommended age of 65.”

Additionally, Dr. Beurskins suggests going over your diet and exercise habits with your physician at annual exams, to be sure you are meeting goals for calcium and vitamin D intake, and getting enough aerobic and weight-bearing exercise to further prevent the progression of bone loss as you age.

Maureen Beurskins, MD reviewed this article.


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Miller, Matthew. E-mail to author, July 14, 2015.

Yi-han Sheu, Amy Lanteigne, Til Stürmer, Virginia Pate, Deborah Azrael, Matthew Miller. SSRI use and risk of fractures among perimenopausal women without mental disorders. BMJ/Injury Prevention, 2015; injuryprev-2014-041483 doi: 10.1136/injuryprev-2014-041483

Diem SJ, Ruppert K, Cauley JA, et al. Rates of bone loss among women initiating antidepressant medication use in midlife. The Journal of Clinical Endocrinology and Metabolism. 2013 Nov;98(11):4355-63. doi: 10.1210/jc.2013-1971

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