Antidepressant, Narcotic Use Tied to Increased Fracture Risk in Older Women

Wednesday, April 30th 2003

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NEW YORK (Reuters Health) Apr 28 - Older women who use antidepressants or narcotics are at increased risk for sustaining a nonspinal fracture compared with nonusers, according to a report published in the April 28th issue of the Archives of Internal Medicine.

In contrast, use of other central nervous system-acting medications, such as benzodiazepines or anticonvulsants, is not associated with an increased fracture risk in these patients, lead author Dr. Kristine E. Ensrud, from the VA Medical Center in Minneapolis, and colleagues note.

Previous reports have suggested that treatment with such medications may increase the risk of falls and fracture. Whether this is, in fact, the case remains unclear because studies investigating the topic have not completely controlled for potential confounders, such as cognition, physical function, or bone mineral density.

The current study involved 8127 women, at least 65 years of age, who were interviewed regarding current medication use and then followed for an average of 4.8 years to determine the occurrence of nonspinal fractures. The study also considered several potential confounders.

Over the course of the study, 1256 (15%) women sustained a fracture, including 288 (4%) who experienced a first hip fracture, the authors note.

Narcotic use and antidepressant use were associated with a 40% and 25% increased risk of nonspinal fracture, respectively. When the analysis was limited to hip fractures, antidepressant use was tied to a 65% increased risk of fracture. After adjusting for gait speed, narcotic use was not a significant predictor of hip fracture.

The researchers also found that women using selective serotonin reuptake inhibitors (SSRIs) were just as likely as those using tricyclics to sustain a nonspinal fracture. Therefore, substituting an SSRI for a tricyclic will probably not bring down the fracture risk, the authors point out.

No link was found between benzodiazepine use and fracture risk, the researchers note. The association that has been made in previous studies "may be largely explained by lower bone density among users of benzodiazepines," they add.

The findings suggest that future studies examining the benefits of CNS-active medications in elderly patients should "include fractures as secondary outcomes," the authors state.

Arch Intern Med 2003;163:949-957

 

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