OBJECTIVES: The purpose of this study was to investigate the increased risk of developing osteoporosis due to depression and/or antidepressants in older adults.

METHODS: Using open health claims and prescription data (2015 Q4 to 2019 Q3) female (F) [median age 66 years] and male (M) [median age 67 years] patients between ages of 55 to 85 and 65 to 85 years were classified into the following cohorts for both genders (C)- C1: Depression with antidepressants-Selective serotonin Reuptake Inhibitors (SSRIs) or Tricyclic Antidepressants (TCAs), C2: Depression with antidepressants- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) or Monoamine Oxidase inhibitors (MAOIs), C3: Only depression (no antidepressants), C4: No depression and not on antidepressants.

RESULTS: We observed an increased risk of osteoporosis in patients diagnosed with depression and not prescribed anti-depressants among both genders [C3 vs C4 - Odds ratio-OR (F)- 1.370254, OR (M)- 1.81021, p <.001]. We also identified a further increased risk of osteoporosis with those receiving anti-depressants and some variation in specific antidepressant categories between genders. Female patients prescribed [SSRI (p =.002) or TCA (p <.001) or SNRI (p=.008) or TCA and SSRI (p <.001)] had increased incidence of osteoporosis versus C3 or C4. Occurrence of Osteoporosis in patients prescribed TCA was higher compared to SSRI as shown by logistic regression coefficients of 0.1746993 (C1) and 0.0563853, respectively. Male patients prescribed SNRI’s (OR- 1.295335, p <.001) showed a significant risk in developing osteoporosis compared to untreated/controls.

CONCLUSIONS: Incidence of osteoporosis was higher in older adults diagnosed with depression and increased further with antidepressants compared to only depression/no depression and not on antidepressants. We recommend adjusting current screening guidelines to reflect this increased risk. We also recommend consideration for more frequent monitoring and greater diligence in screening for osteoporosis in this vulnerable patient population.