May 20, 2014

Selective serotonin reuptake inhibitors (SSRI) and risk of fracture

Query 11-06: Serotonin reuptake inhibitors and risk of fracture. 

This research was funded by the Drug Safety and Effectiveness Network (DSEN) and conducted by the following investigators: C. Moura, S. Bernatsky, M. Abrahamowicz and the CAN-AIM team.

Issue:

  • Some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs), may increase the risk of fractures.
  • The rationale is that these drugs can increase the risk of falls and decrease bone mineral density.

Study aim:

  • To evaluate whether antidepressant medication use is associated with fracture risk.

Study description:

  • We used 10-year data from the Canadian Multicentre Osteoporosis Study (CaMos).
  • The occurrence of fractures was assessed annually, and drug exposure at 3-time points during the study period.
  • Time to event analysis was used to assess the association between SSRI/SNRI use and time to first fragility fracture.

Study findings:

  • Among 6,645 selected participants, 978 experienced at least one fragility fracture.
  • The current use of either SSRI/SNRI was associated with an increased risk of fragility fracture (HR, 1.68; 95 % CI, 1.32–2.14).
  • The results also suggest a dose-effect relationship: participants taking higher doses of SSRI/SNRI at baseline had a significantly higher fracture risk.

Summary:

  • In our analysis using data from a population-based cohort, SSRI/SNRI use was associated with an increased risk of fragility fracture. After controlling for multiple risk factors, the adjusted hazard ratio for current SSRI/SNRI use was elevated (HR, 1.68; 95 % CI, 1.32– 2.14).
  • Our results suggest an independent association between SSRI/SNRI use and subsequent fragility fracture. Given the high prevalence of antidepressants use and the impact of fractures on health, our findings may have a significant clinical impact.

We presented preliminary results at the CAPT Conference in November 2013.

Moura C, Bernatsky S, […], Abrahamowicz M. Psychotropic medication use and 10-year incident fracture risk in men and women ages 50 and older in the population-based Canadian Multicentre Osteoporosis Study (CaMOS). CAPT – ATCP Conference in Toronto, Montreal, QC, November 17-19, 2013.

In January 2014, our manuscript was published in the high-ranking journal Osteoporosis International.

Our results lend additional support to the hypothesis that SSRI/SNRI use is associated with an increased risk of fragility fractures. Given the high prevalence of antidepressants use and the impact of fractures on health, our findings may have a significant clinical impact.

For more information, contact: Autumn Neville, Research Coordinator. [email protected]