Risk of Hip Fracture in Older People Using Selective Serotonin Reuptake Inhibitors and Other Psychoactive Medicines Concurrently: A Matched Case–Control Study in Australia

Abstract

BackgroundFew studies have assessed the risk of hip fracture following concurrent use of psychoactive medicines, and none has investigated combinations with selective serotonin reuptake inhibitors.ObjectivesTo assess the risk of hip fracture in older people as a result of concurrent use of selective serotonin reuptake inhibitors and other psychoactive medicines.MethodsA matched case–control design was employed. Cases were Australian Government Department of Veterans’ Affairs beneficiaries aged over 65 years who experienced a hip fracture between 2009 and 2012. Each case was matched with up to four randomly selected controls of the same age (±2 years) and sex. Medicine-hip fracture associations were estimated via conditional logistic regression. The relative excess risk due to interaction (RERI) was calculated to determine whether combined effects differed from the sum of individual effects.ResultsThere were 8828 cases and 35,310 controls. The median age of subjects was 88 years and 63% were women. The risk of hip fracture was elevated for all medicines assessed individually, most notably selective serotonin reuptake inhibitors (initiation: odds ratio [OR] = 2.7, 95% confidence interval [CI] 2.1, 3.6) and opioids (initiation: OR = 2.3, 95% CI 1.9, 2.9). Combinations associated with an increased odds of hip fracture included addition of benzodiazepines to selective serotonin reuptake inhibitor therapy (OR = 3.0, 95% CI 1.9, 4.8; RERI = 0.9, 95% CI −0.5, 2.3), concurrent use of both opioids and selective serotonin reuptake inhibitors (OR = 2.2, 95% CI 1.9, 2.6; RERI = 0.1, 95% CI −0.3, 0.5), addition of opioids to selective serotonin reuptake inhibitor therapy (OR = 3.2, 95% CI 1.8, 5.5; RERI = −0.1, 95% CI −2.0, 1.7), and initiation of both benzodiazepines and selective serotonin reuptake inhibitors (OR = 4.7, 95% CI 1.7, 13; RERI = 1.3, 95% CI −3.8, 6.3). The RERI results suggested that the effect of each of these medicine combinations equalled the sum of the effects of individual medicine use.ConclusionsIn older people, the concurrent use of selective serotonin reuptake inhibitors and other psychoactive medicines increased the risk of hip fracture as much as the sum of the risks owing to individual medicine use. Our results highlight the need for prescribers to consider the sedative burden of medicines in each older patient as well as the potential for an additive risk of hip fracture when initiating additional psychoactive therapy.

Association rules method and big data: Evaluating frequent medication combinations associated with fractures in older adults

“…Particularly, the results showed that zopiclone was frequently co‐prescribed with other drugs prior to a fracture event. Several studies have shown that z hypnotics significantly increase the risk of fracture in older adults, and our results are biologically plausible …”

“…Several studies have shown that z hypnotics significantly increase the risk of fracture in older adults, and our results are biologically plausible. [30][31][32][33][34] The sensitivity analyses repeated with weekly (7-day) and monthly (30-day) time windows did not change the overall results. These time windows were chosen to align with the best practice recommendations for conducting a case-crossover study.…”

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…Among numerous drugs used for HPI-related diseases many are well known to contribute to OP/OFs. In regard to OP, these include corticosteroids, antidepressants (especially, selective serotonin- and serotonin-norepinephrine reuptake inhibitors), glitazones, opioids, benzodiazepines, antipsychotics, antiparkinsonian drugs, antiepileptics, PPIs, H2RA, thyroxine, furosemide, aromatase inhibitors, gonadotropin releasing hormone (GnRH) agonists, whereas hormone replacement therapy with estrogen, thiazides, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), spironolactone, beta-blockers, statins, antihistamines, metformin, sulphonylureas, glucagon-like peptide-1 receptor agonists (liraglutide) and nitrates have shown an osteoprotective effect [ 316 , 521 , 522 , 523 , 524 , 525 , 526 , 527 , 528 , 529 , 530 , 531 , 532 , 533 , 534 , 535 , 536 , 537 , 538 , 539 , 540 , 541 , 542 , 543 , 544 , 545 , 546 , 547 , 548 , 549 , 550 , 551 , 552 , 553 , 554 ].…”

Combination psychotropic medicine use in older adults and risk of hip fracture

“…An Australian matched case-control study using data from the Australian Government Department of Veterans’ Affairs (DVA) assessed the risk of hip fracture following starting and ongoing use of SSRIs, either alone, or in combination with other psychotropic drugs 12. The study included 8828 veterans with hip fracture and 35,310 matched controls of the same age and gender, and examined their medicine use in the previous six months.…”

“…The study included 8828 veterans with hip fracture and 35,310 matched controls of the same age and gender, and examined their medicine use in the previous six months. The average age of the cohort was 88 years and 63% were women 12…”