Does Sertraline cause bone loss?(5+ risk factors)

This article will focus on answering the question, “Does Sertraline cause bone loss?” We will discuss potential risk factors and tips to prevent and manage bone loss while taking Sertraline.

Does Sertraline cause bone loss?

Yes, Sertraline can cause bone loss. Sertraline (Zoloft) – a selective serotonin receptor inhibitor (SSRI) has been linked to an increased risk of bone loss. It is important to note, however, that this side effect occurs in specific individuals and not everyone who takes this medication will experience it (1,2,3).

Sertraline is a widely prescribed antidepressant for the management of anxiety and depressive disorders. Although the exact mechanism is not fully understood, Sertraline disrupts bone regeneration and repair, creating an imbalance between bone breakdown and formation. This can lead to conditions like osteoporosis, osteoarthritis and fractures (1,2).

What does research suggest?

Research suggests that the use of SSRIs including Sertraline, may impact bone health by influencing bone mineral density, bone wound repair and regeneration and influencing hormone balance.

A comprehensive review that examined the impact of SSRIs on bone health indicated that these medications could potentially reduce bone mineral density  (BMD) and increase the risk of fractures. This study also noted that the use of SSRI medications in patients with risk factors like osteoporosis, history of osteoporosis, ageing, smoking and weight could influence the occurence of bone loss (2,4).

Another study, focused on Sertraline’s effects on bone healing, suggested that this medication impairs bone wound healing by disrupting the process of bone repair and regeneration (3).

Furthermore, a study investigating SSRI medication use and bone loss attributed Sertraline-induced bone loss to reduced serotonin reuptake. This mechanism results in reduced osteoblast proliferation during bone remodelling, leading to decreased bone mineral density and subsequent bone loss (5).

The study also indicated that SSRI users have a 1.44-fold increased risk of low bone density than non-users.

Other studies indicated a higher risk of bone loss in mothers and postmenopausal women due to osteoporosis and decreased bone density (6,7).

What factors increase the risk of bone loss while taking Sertraline?

Several factors can contribute to bone health issues while taking Sertraline or other SSRI medications, such as Citalopram, including (2,4):

• Dosage: Higher doses of the medication may increase the likelihood of experiencing bone loss.
• Age: Aging presents a significant risk for bone loss. As individuals age, their bone mineral decreases, leading to conditions like osteoporosis and an elevated risk of fractures and falls.
• Family history: A family history of osteoporosis and bone fractures can increase the likelihood of bone loss.
• Ethnicity: Caucasian and Asians are at a higher risk of developing bone loss.
• Low body weight: Individuals with a low body mass index (BMI) have a greater likelihood of experiencing bone loss. 
• Underlying health conditions: Certain medical conditions such as thyroid disorders, inflammatory bowel disease and osteoporosis, can elevate the risk of bone loss.
• Nutritional deficiencies: Inadequate calcium and vitamin D intake, stemming from poor nutrition, may increase the likelihood of bone loss.
• Lifestyle factors: Sedentary living, smoking, alcohol consumption and substance abuse may heighten the risk of bone loss.
• Medication interaction: Taking medications that affect bone mineral density, such as corticosteroids alongside Sertraline, increases the likelihood of bone loss.
• Hormonal changes: Hormonal imbalances, such as those associated with menopause or certain medical conditions, can lead to bone loss.

What to do if Sertraline is affecting your bones?

If you are on treatment with Sertraline and have concerns regarding its potential effects on your bones, you should do the following (2,3,4,6):

Consult your healthcare provider:

Before starting treatment with this medication, it is advisable to consider undergoing a DEXA scan, a bone mineral density test. This assessment will help determine whether you already have a bone loss disorder or if you are at risk of developing one while taking Sertraline.

While taking this medication, maintaining open communication with your healthcare provider is essential. You should discuss any concerns and medication side effects with your doctor. Your doctor will evaluate your risk factor profile and customize your treatment plan to address your specific needs.

Furthermore, if you experience frequent symptoms of Sertraline-induced bone loss, such as fractures, you should promptly seek medical assistance.

Lifestyle modifications:

Implementing a healthy lifestyle is crucial for promoting and preventing bone health. Engaging in weight-bearing exercises like strength training promotes bone health.

Furthermore, it is important to include calcium-rich foods in your diet, such as dairy products, leafy greens and fortified foods, to promote bone health.

To enhance calcium absorption and consequently, bone health, you should ensure you spend time in the sun and consider taking vitamin D supplements.

Additionally, to prevent bone loss, it is beneficial to quit smoking, limit excessive alcohol consumption, and avoid substance abuse.

Medication considerations:

Your healthcare provider may also recommend modifying your medication dosage to reduce the likelihood of bone loss. They may also recommend transitioning to a different antidepressant with less likelihood of affecting bone health or discontinuing the medication, under their supervision.

Moreover, your doctor may prescribe over-the-counter (OTC) supplements and medications like bisphosphonates, such as Alendronic acid, to prevent and treat bone loss.

Conclusion

In conclusion, research suggests that the use of SSRIs, including Sertraline, may be associated with bone loss and fractures. While the precise mechanism remains unclear, individual factors such as age can further influence the risk.

References