Use of anti-depressants and the risk of fracture of the hip or femur
Use of anti-depressants and the risk of fracture of the hip or femur
Summary: anti-depressants are used largely, but have serious side effects. We show that both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs) increase the risk of hip/femur fracture and that this risk is time related and depends on the degree of serotonin transporter inhibition. This should be considered when prescribing anti-depressants to patients.
Introduction: anti-depressants are known to have serious side effects. We examined the association between the use of anti-depressants and the risk of hip/femur fractures with a special focus on the relation with the degree of 5-hydroxytryptamine transporter (5-HTT) inhibition and the duration of use.
Methods: a case–control study was conducted within the Dutch PHARMO-RLS database. Cases (n?=?6,763) were adult patients with a first hip/femur fracture during the study period. For each case, four controls (n?=?26341) were matched by age, gender and geographic region.
Results: the risk of hip/femur fracture increased with current use of SSRIs (adjusted odds ratio (ORadj) 2.35 [95% confidence interval (CI) 1.94–2.84]) and TCAs (ORadj 1.76 [95% CI 1.45–2.15]). The risk of hip/femur fracture declined rapidly after discontinuation of use. The risk of hip/femur fracture increased as the degree of 5-HTT inhibition of all anti-depressants increased from ORadj 1.64 [95% CI 1.14–2.35] for drugs with low 5-HTT inhibition to ORadj 2.31 [95% CI 1.94–2.76] for those with high 5-HTT inhibiting properties.
Conclusion: current use of both SSRIs and TCAs increase hip/femur fracture risk. Further studies are needed to elucidate the mechanistic pathways and the relation with the underlying pathophysiology. Until then, the elevated fracture risk should be considered when prescribing anti-depressants
duration of use, fracture, risk, SSRI, 5-HTT inhibition
1705-1713
van den Brand, M.W.M.
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Samson, M.M.
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Pouwels, S.
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van Staa, T.P.
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Thio, B.
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Cooper, C.
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Leufkens, H.G.M.
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Egberts, A.C.G.
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Verhaar, H.J.J.
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de Vries, F.
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October 2009
van den Brand, M.W.M.
2f596aaa-4b58-4fea-b391-51c9e41178ec
Samson, M.M.
d486a2d1-72a3-48e6-a829-457de640ab94
Pouwels, S.
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van Staa, T.P.
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Thio, B.
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Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Leufkens, H.G.M.
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Egberts, A.C.G.
eb765fde-f548-4c1a-8683-5480573617d5
Verhaar, H.J.J.
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de Vries, F.
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van den Brand, M.W.M., Samson, M.M., Pouwels, S., van Staa, T.P., Thio, B., Cooper, C., Leufkens, H.G.M., Egberts, A.C.G., Verhaar, H.J.J. and de Vries, F.
(2009)
Use of anti-depressants and the risk of fracture of the hip or femur.
Osteoporosis International, 20 (10), .
(doi:10.1007/s00198-009-0849-6).
Abstract
Summary: anti-depressants are used largely, but have serious side effects. We show that both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs) increase the risk of hip/femur fracture and that this risk is time related and depends on the degree of serotonin transporter inhibition. This should be considered when prescribing anti-depressants to patients.
Introduction: anti-depressants are known to have serious side effects. We examined the association between the use of anti-depressants and the risk of hip/femur fractures with a special focus on the relation with the degree of 5-hydroxytryptamine transporter (5-HTT) inhibition and the duration of use.
Methods: a case–control study was conducted within the Dutch PHARMO-RLS database. Cases (n?=?6,763) were adult patients with a first hip/femur fracture during the study period. For each case, four controls (n?=?26341) were matched by age, gender and geographic region.
Results: the risk of hip/femur fracture increased with current use of SSRIs (adjusted odds ratio (ORadj) 2.35 [95% confidence interval (CI) 1.94–2.84]) and TCAs (ORadj 1.76 [95% CI 1.45–2.15]). The risk of hip/femur fracture declined rapidly after discontinuation of use. The risk of hip/femur fracture increased as the degree of 5-HTT inhibition of all anti-depressants increased from ORadj 1.64 [95% CI 1.14–2.35] for drugs with low 5-HTT inhibition to ORadj 2.31 [95% CI 1.94–2.76] for those with high 5-HTT inhibiting properties.
Conclusion: current use of both SSRIs and TCAs increase hip/femur fracture risk. Further studies are needed to elucidate the mechanistic pathways and the relation with the underlying pathophysiology. Until then, the elevated fracture risk should be considered when prescribing anti-depressants
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Published date: October 2009
Keywords:
duration of use, fracture, risk, SSRI, 5-HTT inhibition
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Local EPrints ID: 72903
URI: http://eprints.soton.ac.uk/id/eprint/72903
ISSN: 0937-941X
PURE UUID: a4ba0d30-9c27-4e52-80e9-bd103a5eb98f
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Date deposited: 24 Feb 2010
Last modified: 18 Mar 2024 02:44
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Contributors
Author:
M.W.M. van den Brand
Author:
M.M. Samson
Author:
S. Pouwels
Author:
T.P. van Staa
Author:
B. Thio
Author:
H.G.M. Leufkens
Author:
A.C.G. Egberts
Author:
H.J.J. Verhaar
Author:
F. de Vries
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