Effects of Sertraline Use on Bone Microarchitecture: A Literature Review

Abstract

Selective serotonin reuptake inhibitors (SSRIs), particularly sertraline, are widely prescribed for depression and anxiety disorders. Although primarily targeting the central nervous system, emerging evidence suggests that SSRIs can significantly impact bone health. This narrative review aims to evaluate the clinical effects of long term SSRI use on bone mineral density (BMD) and fracture risk. A literature review was conducted across PubMed, Scopus, Web of Science, and Google Scholar, covering studies from 1998 to 2025. Results from both preclinical and clinical data consistently demonstrate a reduction in BMD associated with prolonged SSRI exposure, particularly in trabecular rich anatomical regions such as the femoral neck, vertebrae, and mandible. These changes have been linked to decreased osteoblastic activity and increased bone resorption, leading to structural weakening and elevated fracture risk. Clinical findings suggest that elderly individuals and postmenopausal women are especially vulnerable, and that fracture risk appears to correlate with both the dose and duration of SSRI therapy. While the exact molecular mechanisms remain under investigation, the clinical implications are clear: bone health assessment and monitoring should be integral to the care of patients prescribed SSRIs, particularly those with additional risk factors for osteoporosis. Interventions such as BMD screening, calcium and vitamin D supplementation, and lifestyle modifications may be beneficial in reducing skeletal complications. This review underscores the need for increased clinical awareness and interdisciplinary management strategies to mitigate potential bone-related side effects of SSRI treatment in at risk populations. © 2025, Ondokuz Mayis Universitesi. All rights reserved.