Are Antidepressants Weakening Women’s Bones?

A new study published in the Journal of Affective Disorders finds that antidepressant use is linked to osteoporosis and fractures in adult women.

The research, led by Humam Emad Rajha and Reem Abdelaal of Qatar University, found that antidepressant use—regardless of the type of medication—was associated with a 44% increased risk of developing osteoporosis and a 62% higher risk of fractures. The longer a woman took antidepressants and the more antidepressants she used simultaneously, the greater the risk.

Past research has shown that women are more likely to be prescribed antidepressants than men, often even when they do not report symptoms of depression. As women age, they are also at greater risk of osteoporosis. Given the well-established connection between antidepressants and lower bone mineral density, the authors emphasize the need for careful consideration of bone health risks when prescribing these drugs to women.

“We found that the use of any antidepressant, regardless of class, increased the odds of osteoporosis by 44 % with strong evidence against the model hypothesis for this sample size. Our findings suggest that osteoporosis is an important adverse effect of antidepressant medications. Although the existing evidence on this association is limited, our findings are corroborated by previous other studies conducted in the US, Canada, and Australia that supported the same conclusion: patients using antidepressants were associated with having lower bone mineral density scores than their counterparts.”

This study underscores the long-term physical consequences of psychotropic medication, particularly for women, who are disproportionately prescribed antidepressants. The findings challenge the assumption that these drugs are benign and highlight how biological risks—such as osteoporosis and fractures—are overlooked in favor of symptom management. It raises pressing questions about the ethics of overprescription, the neglect of non-medical interventions, and the broader consequences of a system that prioritizes pharmacological solutions over holistic, person-centered care.

The goal of the current research was to investigate links between the use of various types of antidepressants, osteoporosis, and fractures in adult women from the US. The authors used data from the National Health and Nutrition Examination Survey. This survey collects data on demographics, physical exams, clinical/laboratory tests, imaging results, and nutrition from non-hospitalized participants across the US every two years. In total, data from 30,149 participants was included in the research.

The authors examined data collected between 1999 and 2020 from females who were at least 20 years old. To be included in the current research, participants’ records had to contain complete osteoporosis or bone mineral density data, complete prescription medication data, and complete information related to confounding variables (such as alcohol intake and whether or not they were smokers).

Antidepressant use was determined by asking participants what prescription medications they were taking at the time of the survey. Participants were divided into users and non-users. Users were further divided based on the type of antidepressant they were taking. Antidepressants were classified as SSRIs, SNRIs, phenylpiperazines, and tricyclics. Antidepressants that did not fall into one of these classes were labeled “miscellaneous.”

Osteoporosis status was determined based on responses to a survey question: “Have you ever been told you have osteoporosis or brittle bones?” Additionally, participants were considered to have osteoporosis if they had low bone mineral density scores.

13.1% of participants reported using antidepressants. Women who reported using antidepressants were older on average than non-users and more likely to be post-menopausal (66.9% of users vs 51% of non-users) and taking hormone replacement therapy (24.3% vs 11.8%). Women taking antidepressants were also more likely to be white (51.2% vs 31.4%) and widowed/divorced/separated (23.9% vs 15%). Rates of depression (27.7% vs 7.9%) and osteoporosis (23.5% vs 16.3%) were also higher in women taking antidepressants.

Trends in Antidepressant Prescriptions

Antidepressant use in adult women from the US increased between 1999 and 2020. This was true for all classes of antidepressants. SSRIs were prescribed the most often, followed by SNRIs, miscellaneous phenylpiperazines, and tricyclics.

Between 1999 and 2020, SSRIs, tricyclics, and phenylpiperazines decreased as a percentage of all antidepressant prescriptions. SSRIs comprised just over 56% of antidepressant drugs in 1999. This percentage peaked in 2003 at more than 62% of all prescriptions before falling to less than 52% between 2017 and 2020. Tricyclic antidepressants comprised just under 20% of all prescriptions in 1999 compared to about 7.5% between 2017 and 2020. Phenylpiperazines accounted for about 13% of antidepressant drugs in 1999 compared to just above 10% between 2017 and 2020.

Between 1999 and 2020, SNRIs and miscellaneous antidepressants increased as a percentage of all prescriptions. SNRIs accounted for just over 5% of antidepressant prescriptions in 1999 compared to about 18% between 2017 and 2020. Miscellaneous antidepressants comprised just over 5% of all prescriptions in 1999 compared to about 12% between 2017 and 2020.

Links Between Antidepressant Use, Osteoporosis, and Fractures

Overall, antidepressant use was associated with a 44% increase in the risk of developing osteoporosis. Using multiple antidepressants at the same time increased this risk, as did the duration of antidepressant use. Participants taking two antidepressants had a 78% increased risk of osteoporosis. Those taking three antidepressants were at a 141% increased risk. For each year of antidepressant use, osteoporosis risk increased by 6%.

The researchers found that all classes of antidepressants were linked to increased osteoporosis risk. However, some classes posed a greater risk than others:

• Phenylpiperazines (e.g., trazodone) – 147% increased risk
• Miscellaneous antidepressants – 130% increased risk
• Tricyclics – 114% increased risk
• SSRIs – 88% increased risk
• SNRIs – 46% increased risk

Furthermore, fracture risk also increased with antidepressant use, with some drugs having a stronger correlation to bone fragility than others:

• Miscellaneous antidepressants – 102% increased risk
• Phenylpiperazines – 81% increased risk
• SSRIs – 72% increased risk
• SNRIs – 66% increased risk
• Tricyclics – 64% increased risk

Additionally, the duration and number of antidepressants used further amplified the risk:

• Each additional year of antidepressant use increased osteoporosis risk by 6%.
• Women taking two antidepressants at the same time had a 78% increased risk of osteoporosis.
• Women taking three antidepressants had a staggering 141% increased risk of osteoporosis.

These findings raise concerns about the long-term consequences of prescribing antidepressants—particularly to women who may already be at risk for bone density loss due to aging or other medical factors.

The authors acknowledge several limitations of the current research. The link between osteoporosis risk and antidepressant use was not examined in men due to a lack of bone mineral density data. The study’s design means the current work cannot speak to causation. In other words, the current research shows a link between antidepressants and osteoporosis but cannot definitively say that antidepressants cause osteoporosis. Additionally, this research was conducted on women from the US, limiting generalizability to other populations.

Nevertheless, the findings underscore the need for greater awareness of the risks associated with antidepressant use—especially given the growing prevalence of these medications among women.

“Our cross-sectional study utilizing data from ten cohorts of the National Health and Nutrition Examination Survey (NHANES) revealed significant associations between antidepressant use and osteoporosis among adult women in the United States. Antidepressant use, irrespective of class, increased the odds of developing osteoporosis, with the risk amplifying with the number and duration of concurrent antidepressants used … These findings underscore the need for heightened awareness and consideration of bone health in women prescribed antidepressants, particularly those at higher risk of osteoporosis and MDD.”

Past research has linked the use of SSRIs to bone loss. SSRIs and tricyclic antidepressants have also been linked to increased risk of fractures. One study found that antidepressant use in older people was associated with a two to three-times increased risk of hip fracture.

Experts have expressed concern about the overprescription of antidepressants in women. One study found that 82% of ads for antidepressants target women. Another piece of research found that antidepressants were overprescribed to post-menopausal women despite the risks.

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Rajha, H. E., Abdelaal, R., Charfi, K., Alemadi, A. O., Al-Sheraim, A. S., Al-Maadid, M. A., Louati, Y., Doi, S., & Khaled, S. M. (2025). Examining depression, antidepressants use, and class and their potential associations with osteoporosis and fractures in adult women: Results from ten nhanes cohorts. Journal of Affective Disorders, 369, 1223–1232. (Link)