Evaluation of bone metabolism in patients receiving duloxetine treatment

Objective: To evaluate the effects of duloxetine use on bone mineral density and bone turnover biomarkers. Material and Methods: In this cross-sectional study, 47 patients diagnosed with fibromyalgia and neuropathic pain and using duloxetine for at least 3 months and 47 healthy control group people who did not use the drug were included. Bone formation and resorption markers, serum calcium and vitamin D levels were measured in all patients. Bone mineral density (BMD) was measured by Dual Energy X-Ray Absorptiometry (DXA) method. The relationship between duloxetine usage and bone formation and resorption biomarkers, serum calcium, vitamin D and BMD was evaluated. Results: The study included 47 patients (31 women, 16 men) with a mean age of 41,2±7,6 years who had been using duloxetine for at least 3 months, and 47 healthy control group people with an average age of 41,5±7,4 years. When the patient and control groups were compared, osteocalcin, C-terminal telopeptide (CTX) and alkaline phosphatase (ALP) levels were found to be statistically significantly higher in the patient group. Serum calcium levels were found to be statistically significantly lower in the patient group. When lumbar BMD, femoral neck and femur total BMD were compared, no difference was found between the groups. When the female patient and female control groups were compared, lumbar T and Z scores and lumbar BMD were found to be statistically significantly lower in the female patient group. Conclusions: It is thought that duloxetine treatment may accelerate bone turnover. Lumbar BMD, lumbar T and Z scores were found to be statistically significantly lower in premenopausal female patients using duloxetine compared to the control group. Osteoporosis risk factors should be questioned in premenopausal female patients who are considered for duloxetine treatment, and patients receiving duloxetine treatment should be followed carefully for the development of fractures. Prospective studies investigating the effects of duloxetine use on bone metabolism in different age groups are needed.