Effects of escitalopram on markers of bone turnover: a randomized clinical trial.
Author(s): Diem SJ(1), Joffe H, Larson JC, Tsai JN, Guthrie KA, LaCroix AZ, Ensrud KE,
Freeman EW, Leder BZ.
Affiliation(s): Author information:
(1)University of Minnesota (S.J.D., K.E.E.), Minneapolis, Minnesota 55415;
Brigham and Women's Hospital and Dana Farber Cancer Institute (H.J.), Boston,
Massachusetts 02115; Fred Hutchinson Cancer Research Center (J.C.L., A.Z.L.),
Seattle, Washington 98109; Massachusetts General Hospital (J.N.T., B.Z.L.),
Boston, Massachusetts 02114; Minneapolis Veterans Affairs Health Care System
(K.E.E.), Minneapolis, Minnesota 55417; and Perelman School of Medicine (E.W.F.),
University of Pennsylvania, Philadelphia, Pennsylvania 19104.
Publication date & source: 2014, J Clin Endocrinol Metab. , 99(9):E1732-7
CONTEXT: Recent observational studies have suggested that the use of selective
serotonin reuptake inhibitors is associated with an increased fracture risk and
an accelerated bone loss, although conflicting results have been reported.
Furthermore, because many of these studies have been performed in depressed
women, confounding by indication may influence these findings.
OBJECTIVE: The objective of the study was to determine whether selective
serotonin reuptake inhibitors affect bone metabolism Design: This was a
randomized controlled trial.
SETTING: The study was conducted in four US clinical sites.
PARTICIPANTS: Healthy peri- and postmenopausal women participated in the study.
INTERVENTION: The intervention was escitalopram (10-20 mg/d) for the treatment of
vasomotor symptoms.
MAIN OUTCOME MEASURES: Serum carboxyterminal collagen crosslinks (CTX) and serum
amino-terminal propeptide of type I collagen (P1NP) were measured.
RESULTS: One hundred forty-one peri- or postmenopausal nondepressed women (mean
age 53.7 y, SD 4.1) had baseline and 8-week follow-up samples available for
analysis and were included in the study (69 escitalopram, 72 placebo). The groups
were balanced across a broad range of baseline characteristics, including age,
race, body mass index, smoking status, and mood symptoms. The between-group
differences in the change in CTX and P1NP from baseline to week 8 were compared
by a repeated-measures linear regression model adjusted for race, clinical
center, and baseline measurement. Treatment with escitalopram reduced serum P1NP
by 1.02 ng/mL on average [95% confidence interval (CI) -5.17, 3.12] compared with
a reduction of 1.88 ng/mL (95% CI -4.82, 1.06) in the placebo group (P = .65).
Similarly, serum CTX decreased 0.02 ng/mL on average (95% CI -0.05, 0.01) in the
escitalopram group compared with 0.00 ng/mL (95% CI -0.02, 0.02) in the placebo
group (P = .24). The results were similar when the analysis was restricted to
those women whose adherence to study medication was 70% or greater.
CONCLUSIONS: Although the study was limited to 8 weeks, these results suggest
that escitalopram does not significantly alter bone metabolism in the short term.
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