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Let’s look at the relationship between antidepressants and osteoporosis. Antidepressants have been associated with an increased risk of bone fracture multiple times. However, is that because antidepressants cause these increased fracture rates? Or, might it be because depression causes increased fracture rates, and depression also causes antidepressants to be prescribed to people? In other words, before we accept a causal relationship between antidepressants and hip fractures, we have to consider other reasons for that connection. One critical reason is called confounding by indication. The drug appears guilty only because the illness is the basis of the problem. So, are antidepressants innocent as regards [to] osteoporosis? They are associated with hip fractures. Nevertheless, is that confounding by indication?
This key question has been examined recently by Dr. Chittaranjan Andrade in the Journal of Clinical Psychiatry . Dr. Andrade makes it clear that depression can contribute to osteoporosis through mechanisms such as
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