Selective Serotonin Reuptake Inhibitors Increase Fracture Risk in Older Adults

Saturday, March 17th 2007

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anuary 23, 2007 - The use of selective serotonin reuptake inhibitors (SSRIs) increases the risk for fracture, falling, and lower bone mineral density (BMD) in older adults, according to the results of a population-based, randomly selected, prospective cohort study reported in the January 22 issue of the Archives of Internal Medicine.

"Depression and osteoporotic fractures are common ailments among elderly persons. SSRIs are frequently used in the treatment of depression in this population, and the association between daily SSRI use and fragility fractures is unclear," write J. Brent Richards, MD, of McGill University and Royal Victoria Hospital in Montreal, Quebec, and colleagues from the Canadian Multicentre Osteoporosis Study (CaMos) Research Group. "Our objective was to examine the effect of daily SSRI use on the risk of incident clinical fragility fracture."

A population-based, randomly selected, cohort of 5008 community-dwelling adults 50 years and older was prospectively followed up during 5 years for incident fractures. Risk was determined for clinical fragility fractures, defined as minimal trauma fractures that were clinically reported and radiographically confirmed, associated with daily SSRI use.

Daily use of SSRIs was reported by 137 subjects. After adjustment for many potential covariates, daily SSRI use was associated with double the risk for incident clinical fragility fracture (hazard rate [HR], 2.1; 95% confidence interval [CI], 1.3 - 3.4). Daily SSRI use was also associated with increased risk for falls (odds ratio, 2.2; 95% CI, 1.4 - 3.5), lower BMD at the hip, and a trend toward lower BMD at the spine. These effects were dose dependent and similar for those who reported taking SSRIs at baseline and at 5 years' follow-up.

"Daily SSRI use in adults 50 years and older remained associated with a 2-fold increased risk of clinical fragility fracture after adjustment for potential covariates," the authors write. "Depression and fragility fractures are common in this age group, and the elevated risk attributed to daily SSRI use may have important public health consequences."

Study limitations include unknown duration of daily SSRI use, precluding estimation of the effect of duration of use on fractures; and subjects not evaluated by a psychiatrist for a diagnosis of depression.

"Daily SSRI use in this population to treat depression may increase the risk of subsequent fracture," the authors conclude. "These risks must be balanced against the benefits gained by the treatment of depression with SSRIs. In light of the high rate of SSRI use among the general population, and among elderly persons in particular, further studies that include controlled prospective trials are needed to confirm our findings."

The Canadian Institutes of Health supported this study. The authors have disclosed no relevant financial relationships with Amgen; Eli Lilly, the maker of fluoxetine; Proctor & Gamble; Sanofi-Aventis; Merck Frosst; and/or Novartis.

Arch Intern Med. 2007;167:188-194.

 

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