Background: fibromyalgia is characterized by chronic widespread pain classified as primary and concomitant. Aim of the Work: this work aimed to determine the correlation between selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) usage and bone mineral density (BMD) and trabecular bone score (TBS) changes in primary fibromyalgia patients. Patients and Methods: The present study was conducted on study on 100 Egyptian patients diagnosed as primary fibromyalgia categorized according to drug medication into two 2 groups, 50 patients on SSRIs and 50 patients on SNRIs, recruited from Rheumatology, Physical Medicine and Rehabilitation Departments at Al-Hussein and Sayed Galal, Al-Azhar University Hospitals. In addition to another 50 age matched the control group subdivided into 25 primary fibromyalgia patients not on those drugs and 25 healthy individuals selected by nurses and medical staff, after an informed consent from all subjects from June 2018 to December 2018.Results: DXA and TBS revealed that usage of SSRIs and SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (partially degraded and degraded) particularly for old people. Conclusion: the present study provided evidence that usage of SSRIs or SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (Partially degraded and degraded) particularly for old people and despite low BMD was found in the SRI users; it also found in 1^ry fibromyalgia not on SRIs so 1^ry fibromyalgia should also be considered as a contributing factor for low BMD.