Association of Selective Serotonin Reuptake Inhibitors and Bone Mineral Density in Elderly Women.

Depression and osteoporosis are 2 common comorbidities in geriatric patients. There are concerns about the deleterious effects of selective serotonin reuptake inhibitor (SSRI) antidepressant use on bone mineral density (BMD). We examined the association between SSRI use and BMD in elderly women (≥65 yr) referred to a geriatric osteoporosis clinic for bone health evaluation. Cross-sectional analyses using the general linear model were performed on data collected retrospectively from August 2010 to April 2015. A total of 250 women were seen during the study period. Of these, 140 women had complete data on BMD measurements: 22 (15.7%) used an SSRI and 118 (84.3%) did not. The 2 groups, SSRI users and SSRI nonusers, did not differ significantly across any of the covariates tested (age, ethnicity, body mass index, and past and present osteoporosis treatment medications). After adjusting for covariates, there was no difference in the BMDs at the femoral neck (p = 0.887) or the spine (p = 0.275) between the 2 groups. Similarly, no difference was seen in the T-scores between SSRI users and nonusers at the femoral neck (p = 0.924) or at the spine level (p = 0.393). Our study did not show an association between SSRI use and BMD among elderly women referred for bone health evaluation. Other studies in the literature have been inconclusive, and therefore, robust longitudinal studies are needed to further assess the interaction between SSRI use and predictors of fracture such as BMD, bone turnover markers, and genes involved in bone turnover. Until then, clinicians should closely monitor the bone health of long-term SSRI users.

Suboptimal vitamin D screening in older patients with compromised skeletal health.

RATIONALE, AIMS AND OBJECTIVES: Increasing number of primary care visits for osteoporosis by older patients combined with new vitamin D screening recommendations necessitate primary care providers (PCPs) to identify and screen at-risk patients. We described prevalence and determinants of vitamin D screening among older patients treated for osteopoenia, osteoporosis and related fractures in academic outpatient primary care clinics (family medicine and geriatric medicine) in Houston, TX. METHODS: Electronic chart review collected data on patients ≥50 years old from January 2008 to December 2010. Orders for serum 25-hydroxy vitamin D indicated vitamin D screening. Differences in patient characteristics were described between the groups with and without vitamin D screening. Age, body mass index, racial/ethnic background, bone-promoting medication (BPM) use and clinic types (family medicine versus geriatric medicine) were determinants for vitamin D screening in the regression analysis. RESULTS: Patients were mostly women (95%), Caucasian (65%) and had a mean age of 69 ± 12 years. Twenty-two per cent of the family medicine clinic patients (total n = 78) and 51% of the geriatric medicine clinics patients (total n = 70) were screened. Older age (odds ratio, 0.94 confidence interval = 0.90-0.99) and BPM use (2.58, 1.03 to 6.45) were significant positive determinants for vitamin D screening. CONCLUSIONS: In primary care clinics, vitamin D screening remains low among patients diagnosed with osteopoenia, osteoporosis and fractures. In light of new guidelines, suboptimal screening in the vulnerable older patients is disturbing. We recommend increased PCPs' awareness about vitamin D screening guidelines for improving skeletal health in older patients.