Antidepressants Linked to Increased Bone Fracture Risk
By editor | May 12, 2007
An antidepressant, in the most common usage, is a psychiatric medication taken to alleviate clinical depression or dysthymia (’milder’ depression). Several groups of drugs are particularly associated with the term, notably MAOIs and tricyclics (whose serendipitous discovery and psychiatric use dates from the 1950s) as well as SSRIs and more recent variations developed by pharmaceutical companies.
The new research, led by Dr. David Goltzman, a professor of medicine and physiology and director of the McGill Centre for Bone and Periodontal Research at McGill University in Montreal, seems to support the earlier studies.
"There is good scientific evidence that serotonin is involved in bone physiology, and if you alter the system, you can get low bone density," Goltzman said. "Patients should be monitored to prevent the risk of fractures."
For the study, Goltzman and his colleagues reviewed information on 137 patients — average age 65 — who took SSRIs. The patients had their bone mineral density measured at the start of the study and were followed for five years. Each year, the patients were also asked to report any fractures they had and how they occurred.
Goltzman’s team found these patients had twice the risk of fractures. They were particularly vulnerable to breaks of the forearm, ankle and foot, and less so to fractures of the hip, rib, femur, and back, the study found.
Goltzman’s group also found that use of SSRIs was associated with an increased risk of falling. The effect depended on the dose of the drug. Doubling the dose resulted in a 1.5-fold increase in the risk of falling.
Daily SSRI use was also associated with a 4 percent decrease in bone mineral density at the hip, and a 2.4 percent decrease at the spine, the researchers reported.
The research was conducted by a team of scientists from various Canadian research centres.
They looked at data from a group of patients of average age 65.1 who were aged 50 and over who were taking SSRI antidepressants on a daily basis. These patients were part of a larger study under the umbrella of the Canadian Multicentre Osteoporosis Study (CaMos) Research Group. The CaMos group comprises a randomly selected, population-based cohort of 5008 adults aged 50 and over who are followed over 5 years for incident fractures.
The patients had been filling in questionnaires about their bone breakages cause by various minor events such as falling out of bed, off a chair, or similar minimal trauma incidents. All the fractures had been confirmed with radiographs.
The researchers found 137 patients within the CaMos cohort who were using SSRIs on a daily basis. The SSRIs they were using included: fluvoxamine (brand name uvox), citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil). These were the ones that were on the market at the start of the CaMos study.
After correlating the data from the bone fractures with the data on the SSRI intake, the results showed that taking SSRI antidepressants every day doubled the risk of "clinical fragility fracture" in adults aged 50 and over, even after taking into account various other factors such as age, hip bone mineral density, and estrogen levels.
The also found a dosage effect, where a 1.5 increase in risk of bone fracture was linked to a doubling of daily dose of SSRI.
The researchers suggest that doctors should take into account the risk of fragility fracture when they prescribe SSRI antidepressants to patients in this age group.
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants used to treat anxiety and personality disorders and depression. They increase the level of serotonin in the brain by stopping it being reabsorbed by the presynpatic cell, which leaves more of it around to produce its mood-altering effects.
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