REVIEW OF: Bulut SD et al, J Clin Densitom 2025;28(1):101538
STUDY TYPE: Cross-sectional cohort study

SSRIs have been linked to bone thinning and fractures, which matters most for postmenopausal women already at risk. Whether SNRIs carry the same concern has been unclear.

This study looked at 163 postmenopausal women ages 50–65 with generalized anxiety disorder (GAD): 63 treated with SNRIs (duloxetine or venlafaxine), 60 treated with SSRIs (citalopram, sertraline, or paroxetine), and 40 healthy controls. All patients had been on medication for at least six months, and women with depression or other medical causes of bone loss were excluded. SNRI users had longer treatment exposures, higher doses, and smoked more. Bone density at multiple sites was compared across groups.

Overall bone density was similar in all groups, but a consistent pattern stood out. Women taking SSRIs showed early bone thinning in the lumbar spine, while those taking SNRIs did not. When bone density was compared to expected values for age, SSRI users again came out worse than both SNRI users and healthy controls. There were no significant differences between duloxetine and venlafaxine. Dose and duration of SNRI use were not linked to worse bone outcomes.

CARLAT TAKE
This small, cross-sectional study did not control for sun, exercise, or vitamin D exposure. These findings therefore aren’t definitive, but for a postmenopausal patient with GAD who needs long-term antidepressants, SNRIs may be safer for bone health than SSRIs. Conversations that encompass bone density and anxiety are also opportunities to remind patients that weight-bearing exercise and smoking cessation can address both.