Does Cymbalta affect bone density? (3 other factors)

This article will discuss the impact of Cymbalta on bone density and explore the findings from various studies conducted on mice and humans. Additionally, it will explore the factors that can influence bone density while taking Cymbalta.

Finally, the article will provide recommendations on how to optimize bone health while taking Cymbalta and address the symptoms of decreased bone density.

Does Cymbalta affect bone density?

No, Cymbalta does not affect bone density. Trials conducted on mice have found that it can increase bone mineral density, but there is not enough research on the effect of Cymbalta on human bone mineral density.

Cymbalta may also be very helpful in reducing osteoporosis-related pain in some people, and there are no reports of any bone mineral density side effects from Cymbalta. 

If you have concerns regarding reduced bone density while taking Cymbalta, it is advisable to consult with a doctor or healthcare professional. They will be able to provide guidance and address any specific concerns you may have.

How can Cymbalta affect bones?

Bone mineral density relies on the balance between osteoclasts and osteoblasts. Osteoclasts are cells in our body that break down old bone tissue, and their regulation is crucial to maintaining bone health [1].

Cymbalta mainly works by increasing serotonin and norepinephrine in the brain. However, researchers have found that duloxetine can also inhibit the expression of NFATc1, a major genetic factor in the formation and function of osteoclasts [1].

To illustrate, duloxetine was found to inhibit the phosphorylation of ERK, which is a molecule involved in the MAPK pathway. This blocks the signals that would normally trigger the expression of NFATc1 [1].

As a result, the formation and function of osteoclasts are inhibited, leading to a reduced breakdown of bone tissue and promoting bone density [1].

Furthermore, scientists investigated the effects of exposing bone cells to duloxetine. They found that duloxetine can activate certain proteins (namely P38 and c-Jun) through a signaling molecule called prostaglandin E1 (PGE1) [2].

This resulted in increased production of a protein called osteoprotegerin (OPG) and promoted the activation of osteoblasts, which are cells responsible for bone formation [2].

What does research suggest?

A study evaluated the effects of duloxetine on pain and bone mineral density in patients with osteoporosis. The patients who took duloxetine for three months experienced an average low back pain score of 1.70 out of 10, which was lower compared to the control group’s pain score of 3.49 out of 10 [3].

Additionally, after one year of duloxetine treatment, there was a 0.06 g/L increase in bone mineral density. These findings suggest that duloxetine may alleviate osteoporosis-related pain without compromising bone density [3].

In another study, researchers induced a state that resembled menopause-induced osteoporosis in mice by performing an ovariectomy on them. They then treated these mice with duloxetine to study its effects on ovariectomy-induced bone loss [1].

The findings indicated that the bone volume and trabecular number were significantly increased in the mice that underwent treatment compared to the control group [1].

After conducting further in vitro testing, the scientists found that duloxetine inhibited the function of osteoclasts. Finally, the study concluded that duloxetine may enhance bone mineral density in postmenopausal osteoporosis [1].

What factors influence bone density while taking Cymbalta?

Multiple factors can affect bone mineral density while taking Cymbalta. The most important risk factors for decreased bone mineral density (BMD) include calcium and vitamin D deficiencies. Additionally, post-menopausal women are the most likely to experience decreased BMD while on Cymbalta.

What diseases affect bone density?

Certain diseases can increase the likelihood of experiencing decreased bone density while taking Cymbalta.

For instance, any disease that elevates catabolic hormones can contribute to bone loss. Conditions such as Cushing’s syndrome and hyperthyroidism can place the body in a catabolic state, resulting in greater bone loss compared to bone building.

In addition, hypogonadism, estrogen deficiency, or testosterone deficiency can also predispose individuals to decreased bone mineral density. These diseases involve a decrease in the hormones that protect the bones.

Furthermore, renal hypercalciuria is a genetic disease in which individuals tend to excrete abnormal amounts of calcium.

What other medications affect bone density?

The concurrent administration of certain medications can increase the risk of osteoporosis while administering Cymbalta. For instance, high doses of corticosteroids can lead to decreased bone mineral density. Furosemide, a diuretic, increases calcium excretion, which may negatively impact bones.

Furthermore, certain anticonvulsants, such as phenytoin, barbiturates, and carbamazepine, have been found to decrease bone mineral density. People who take excessive amounts of thyroxine are also more likely to suffer from osteoporosis while taking Cymbalta.

Lifestyle factors

Smoking and alcoholism are risk factors for osteoporosis. Additionally, inactivity can negatively impact one’s physical health, especially their bone health. Most importantly, people who don’t eat food that contains calcium are more likely to experience reduced bone density while on Cymbalta.

Having adequate levels of vitamin D is essential for optimizing bone health. Thus, people who don’t go out in the morning and don’t get exposed to sunlight are at higher risk of vitamin D deficiency and are consequently likely to suffer from osteoporosis while administering Cymbalta.

What are the symptoms of decreased bone density?

If you are concerned about your bone mineral density while taking Cymbala, it is important to be aware of the symptoms of reduced bone mineral density. Firstly, individuals with reduced bone density may experience pain and immobility in their back, hip, or arm.

In more severe cases, where a patient is osteopenic or osteoporotic, they may find that fractures occur more easily after bending, lifting, or falling, or even without any specific event. 

Over the long term, decreased bone mineral density can result in abnormal bending of the spine, known as lordosis or kyphosis. This can lead to a decrease in the height of osteoporotic patients by 3.8 cm or more.

How to optimize bone health while taking Cymbalta?

If you experience compromised bone density while taking Cymbalta, it is important to take certain measures to optimize your bone health.

However, it is crucial to consult with a doctor first. They will obtain a detailed medical history, perform physical examinations, and conduct diagnostic studies to assess your risk of decreased bone density.

If necessary, they may also perform a DXA scan to determine your bone mineral density. In addition to consulting with your doctor, there are universal recommendations for all patients to optimize bone health while taking Cymbalta.

Lifestyle adjustments

These include adequate calcium and vitamin D intake, treatment of vitamin D deficiency, regular weight-bearing and muscle-strengthening exercise, fall prevention strategies, cessation of tobacco use, and avoidance of excessive alcohol intake.

If your doctor determines that you have compromised bone mineral density, it is important to be cautious when moving to minimize the risk of falls and fractures.

You should be aware of the risk factors for falls, such as low-level lighting, medical risk factors like age and poor vision, and medications causing sedation, like certain analgesics and anticonvulsants.

Strategies such as physical activity, modifying your home environment, assessing your vision, using ambulation-assistive devices, and eliminating unnecessary medications that may induce sedation can help reduce the risk of falls.


In some cases, your doctor may also prescribe additional medications alongside Cymbalta to improve your bone mineral density:

  • The first-line treatment options for osteopenia or osteoporosis are bisphosphonates, which mimic a natural inhibitor of bone breakdown in our bodies.
  • Second-line options include RANKL inhibitors such as denosumab, which block a molecule that stimulates bone resorption.
  • Other medications, such as parathyroid hormone and estrogen supplements for post-menopausal women, may also be considered.
  • If these treatments fail, calcitonin can be considered as a last-line option.


Based on my research, I have concluded that Cymbalta does not affect bone density. Trials conducted on mice have shown that it can increase bone mineral density. Furthermore, I found that Cymbalta may help reduce osteoporosis-related pain in some individuals.

Based on my knowledge, factors such as calcium and vitamin D deficiencies, certain diseases, and the concurrent use of other medications can influence bone density while taking Cymbalta. Lifestyle factors like smoking, alcoholism, and inactivity can also have a negative impact.

If you experience compromised bone density while taking Cymbalta, I recommend consuming adequate calcium and vitamin D, engaging in regular weight-bearing exercise, and considering fall prevention strategies.

In some cases, your doctor may also prescribe additional medications to improve your bone mineral density.

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Zhou W, Zhou W, Bi Y, Zhou Z, Zhou Z, Chen S, Xie G, Lian Z, Yuan G, Yao G. Antidepressant duloxetine hydrochloride protects against ovariectomy-induced bone loss in mice by inhibiting osteoclast differentiation. Biomed Pharmacother. 2023 Dec;168:115810. doi: 10.1016/j.biopha.2023.115810. Epub 2023 Oct 30. PMID: 37913736.,or%20postmenopausal%20depression%20using%20antidepressants.


Junko Tachi, Haruhiko Tokuda, Takashi Onuma, Shinobu Yamaguchi, Woo Kim, Tomoyuki Hioki, Rie Matsushima-Nishiwaki, Kumiko Tanabe, Osamu Kozawa, Hiroki Iida, Duloxetine strengthens osteoblast activation by prostaglandin E1: Upregulation of p38 MAP kinase, Prostaglandins & Other Lipid Mediators, Volume 151, 2020, 106481, ISSN 1098-8823,


Sun, Y., Hu, C. & Song, X. RETRACTED ARTICLE: Clinical effect of duloxetine on improving osteoporosis low back pain in older adults. Appl Nanosci 13, 1647–1653 (2023).

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