Use of antidepressant drugs and risk of osteoporotic and non-osteoporotic fractures
Use of antidepressant drugs and risk of osteoporotic and non-osteoporotic fractures
Aim: Both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of fractures. The serotonin transporter (5-HTT) has been located in the bone and may play a role in bone physiology. We assessed the association between antidepressant drug use, categorized in a therapeutical-based way and on basis of their affinity for the 5-HTT, and the risk of both osteoporotic and non-osteoporotic fractures.
Methods: A case–control study was conducted using the PHARMO RLS. Cases were patients with a first hospital admission for a fracture during the study period. Up to four controls were matched to each case on gender, age, geographical area, and index date.
Results: We identified 16,717 cases, of whom 59.5% had an osteoporotic fracture, and 61,517 controls. Compared to no use, current use of SSRIs was associated with a statistically significant increased risk of osteoporotic fractures (OR 1.95, 95% CI 1.69–2.26), as was current use of TCAs and non-SSRI/non-TCA antidepressant drugs (ORs 1.37, 95% CI 1.16–1.63 and 1.40, 95% CI 1.06–1.85, respectively). The risk of an osteoporotic fracture was statistically significantly higher for antidepressants with a high affinity for the 5-HTT (OR 1.86, 95% CI 1.63–2.13) compared to antidepressants with a medium or low affinity (OR 1.43, 95% CI 1.19–1.72 (medium) and OR 1.32 95% CI 0.98–1.79 (low) (p < 0.05 for trend). The risk of non-osteoporotic fractures did not show the same trend.
Conclusions: The extent of affinity for the 5-HTT may contribute to the increased risk of osteoporotic fractures related to antidepressant drug use. The pharmacological mechanism-based classification could to be an appropriate alternative for traditional classification to study the association between the use of antidepressants and the risk of fractures.
antidepressants, epidemiology, fractures, serotonin, osteoporosis
604-609
Verdel, Bertha Maria
bed1e280-e6dc-42f5-b124-80c53c7fa6d4
Souverein, Patrick C.
f03a0bb7-345e-4679-8368-495bd05df068
Egberts, Toine C.G.
063491c6-a953-41f9-b185-1c5920e43ef6
Van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb
Leufkens, Hubert G.M.
299d1b54-3a02-48a9-9ffb-71ba2c3fa469
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
September 2010
Verdel, Bertha Maria
bed1e280-e6dc-42f5-b124-80c53c7fa6d4
Souverein, Patrick C.
f03a0bb7-345e-4679-8368-495bd05df068
Egberts, Toine C.G.
063491c6-a953-41f9-b185-1c5920e43ef6
Van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb
Leufkens, Hubert G.M.
299d1b54-3a02-48a9-9ffb-71ba2c3fa469
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Verdel, Bertha Maria, Souverein, Patrick C., Egberts, Toine C.G., Van Staa, Tjeerd P., Leufkens, Hubert G.M. and de Vries, Frank
(2010)
Use of antidepressant drugs and risk of osteoporotic and non-osteoporotic fractures.
Bone, 47 (3), .
(doi:10.1016/j.bone.2010.06.006).
Abstract
Aim: Both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of fractures. The serotonin transporter (5-HTT) has been located in the bone and may play a role in bone physiology. We assessed the association between antidepressant drug use, categorized in a therapeutical-based way and on basis of their affinity for the 5-HTT, and the risk of both osteoporotic and non-osteoporotic fractures.
Methods: A case–control study was conducted using the PHARMO RLS. Cases were patients with a first hospital admission for a fracture during the study period. Up to four controls were matched to each case on gender, age, geographical area, and index date.
Results: We identified 16,717 cases, of whom 59.5% had an osteoporotic fracture, and 61,517 controls. Compared to no use, current use of SSRIs was associated with a statistically significant increased risk of osteoporotic fractures (OR 1.95, 95% CI 1.69–2.26), as was current use of TCAs and non-SSRI/non-TCA antidepressant drugs (ORs 1.37, 95% CI 1.16–1.63 and 1.40, 95% CI 1.06–1.85, respectively). The risk of an osteoporotic fracture was statistically significantly higher for antidepressants with a high affinity for the 5-HTT (OR 1.86, 95% CI 1.63–2.13) compared to antidepressants with a medium or low affinity (OR 1.43, 95% CI 1.19–1.72 (medium) and OR 1.32 95% CI 0.98–1.79 (low) (p < 0.05 for trend). The risk of non-osteoporotic fractures did not show the same trend.
Conclusions: The extent of affinity for the 5-HTT may contribute to the increased risk of osteoporotic fractures related to antidepressant drug use. The pharmacological mechanism-based classification could to be an appropriate alternative for traditional classification to study the association between the use of antidepressants and the risk of fractures.
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Published date: September 2010
Keywords:
antidepressants, epidemiology, fractures, serotonin, osteoporosis
Organisations:
Medicine
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Local EPrints ID: 183335
URI: http://eprints.soton.ac.uk/id/eprint/183335
ISSN: 8756-3282
PURE UUID: 43ef87dd-c7e0-4598-96db-c254894a377c
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Date deposited: 03 May 2011 10:28
Last modified: 14 Mar 2024 03:02
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Author:
Bertha Maria Verdel
Author:
Patrick C. Souverein
Author:
Toine C.G. Egberts
Author:
Tjeerd P. Van Staa
Author:
Hubert G.M. Leufkens
Author:
Frank de Vries
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