Tags

Type your tag names separated by a space and hit enter

Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures.
J Clin Psychopharmacol. 2008 Aug; 28(4):411-7.JC

Abstract

BACKGROUND

Fractures related to osteoporosis and falling constitute a major health problem in the elderly population. Exposure to antidepressants is associated with an increased risk of falls and fractures, but most previous studies incriminate tricyclic antidepressants (TCAs) rather than selective serotonin reuptake inhibitors (SSRIs).

OBJECTIVE

To examine the association between antidepressants, including TCAs, SSRIs, and other antidepressants and the risk of nonvertebral fractures in elderly.

DESIGN

Prospective population-based cohort study.

SETTING

The Rotterdam Study, consisting of 7983 individuals aged 55 years and older.

PARTICIPANTS

All persons from the Rotterdam Study.

RESULTS

One thousand two hundred nineteen persons experienced a nonvertebral fracture, 25 during TCA use and 18 during SSRI use. After adjustment for age, sex, lower-limb disability, and depression, the risk of nonvertebral fracture was 2.35 (95% confidence interval, 1.32-4.18) for current users of SSRIs compared with nonusers of antidepressants. Multiple adjusting for many possible risk factors did not affect the association. To deal with potential confounding by indication, we subsequently restricted the analysis to antidepressant users (n = 1217). Compared with past users of TCAs or SSRIs, current users of SSRIs had a 2.07-fold (95% confidence interval, 1.23-3.50) increased risk of fracture, which further increased with prolonged use. In this analysis, depressive state at baseline and during follow-up did not play a role, suggesting absence of confounding by indication. The use of TCAs was associated with an increased fracture risk that decreased with prolonged use.

CONCLUSIONS

Not only users of TCAs but also of SSRIs have a significantly increased risk of nonvertebral fractures, in SSRI users especially after prolonged use. Despite fewer early adverse effects of SSRIs, physicians treating elderly depressive patients should be aware of the unfavorable long-term consequence of SSRIs on fracture risk.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18626268

Citation

Ziere, Gijsbertus, et al. "Selective Serotonin Reuptake Inhibiting Antidepressants Are Associated With an Increased Risk of Nonvertebral Fractures." Journal of Clinical Psychopharmacology, vol. 28, no. 4, 2008, pp. 411-7.
Ziere G, Dieleman JP, van der Cammen TJ, et al. Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. J Clin Psychopharmacol. 2008;28(4):411-7.
Ziere, G., Dieleman, J. P., van der Cammen, T. J., Hofman, A., Pols, H. A., & Stricker, B. H. (2008). Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. Journal of Clinical Psychopharmacology, 28(4), 411-7. https://doi.org/10.1097/JCP.0b013e31817e0ecb
Ziere G, et al. Selective Serotonin Reuptake Inhibiting Antidepressants Are Associated With an Increased Risk of Nonvertebral Fractures. J Clin Psychopharmacol. 2008;28(4):411-7. PubMed PMID: 18626268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. AU - Ziere,Gijsbertus, AU - Dieleman,Jeanne P, AU - van der Cammen,Tischa J M, AU - Hofman,Albert, AU - Pols,Huibert A P, AU - Stricker,Bruno H Ch, PY - 2008/7/16/pubmed PY - 2008/10/25/medline PY - 2008/7/16/entrez SP - 411 EP - 7 JF - Journal of clinical psychopharmacology JO - J Clin Psychopharmacol VL - 28 IS - 4 N2 - BACKGROUND: Fractures related to osteoporosis and falling constitute a major health problem in the elderly population. Exposure to antidepressants is associated with an increased risk of falls and fractures, but most previous studies incriminate tricyclic antidepressants (TCAs) rather than selective serotonin reuptake inhibitors (SSRIs). OBJECTIVE: To examine the association between antidepressants, including TCAs, SSRIs, and other antidepressants and the risk of nonvertebral fractures in elderly. DESIGN: Prospective population-based cohort study. SETTING: The Rotterdam Study, consisting of 7983 individuals aged 55 years and older. PARTICIPANTS: All persons from the Rotterdam Study. RESULTS: One thousand two hundred nineteen persons experienced a nonvertebral fracture, 25 during TCA use and 18 during SSRI use. After adjustment for age, sex, lower-limb disability, and depression, the risk of nonvertebral fracture was 2.35 (95% confidence interval, 1.32-4.18) for current users of SSRIs compared with nonusers of antidepressants. Multiple adjusting for many possible risk factors did not affect the association. To deal with potential confounding by indication, we subsequently restricted the analysis to antidepressant users (n = 1217). Compared with past users of TCAs or SSRIs, current users of SSRIs had a 2.07-fold (95% confidence interval, 1.23-3.50) increased risk of fracture, which further increased with prolonged use. In this analysis, depressive state at baseline and during follow-up did not play a role, suggesting absence of confounding by indication. The use of TCAs was associated with an increased fracture risk that decreased with prolonged use. CONCLUSIONS: Not only users of TCAs but also of SSRIs have a significantly increased risk of nonvertebral fractures, in SSRI users especially after prolonged use. Despite fewer early adverse effects of SSRIs, physicians treating elderly depressive patients should be aware of the unfavorable long-term consequence of SSRIs on fracture risk. SN - 1533-712X UR - https://www.unboundmedicine.com/medline/citation/18626268/Selective_serotonin_reuptake_inhibiting_antidepressants_are_associated_with_an_increased_risk_of_nonvertebral_fractures_ L2 - http://dx.doi.org/10.1097/JCP.0b013e31817e0ecb DB - PRIME DP - Unbound Medicine ER -