Selective Serotonin Reuptake Inhibiting Antidepressants Are Associated With an Increased Risk of Nonvertebral Fractures

Ziere, Gijsbertus; Dieleman, Jeanne P.; Cammen, Tischa J. M. van der; Hofman, Albert; Pols, Huibert A. P.; Stricker, Bruno H.

doi:10.1097/jcp.0b013e31817e0ecb

Cited by 127 publications

(139 citation statements)

References 47 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…54,55 This association was first observed in a series of case-control studies using large administrative databases [54][55][56] but has since been replicated with prospective cohort studies. 57,58 In a multivariate analysis, controlling for such factors as depressive symptoms, falls history, visual and cognitive impairment, comorbidities, postural hypotension, other medications, alcohol and smoking, the risk of fragility fracture over 8 years with current SSRI use was found to be 2.35 (1.3-4.2). 57 SSRIs also have been found to have a dose relationship with fractures.…”

Section: Depression Antidepressants and Fracturesmentioning

confidence: 99%

“…57,58 In a multivariate analysis, controlling for such factors as depressive symptoms, falls history, visual and cognitive impairment, comorbidities, postural hypotension, other medications, alcohol and smoking, the risk of fragility fracture over 8 years with current SSRI use was found to be 2.35 (1.3-4.2). 57 SSRIs also have been found to have a dose relationship with fractures. 54,58 Similar to the risk for falls, the risk of fracture associated with SSRI use is the highest in the first 2 weeks of treatment (OR: 6.30; CI: 2.65-14.97) but remains elevated with continuous antidepressant use beyond the first month of use (OR: 1.32; CI: 1.19-1.48).…”

Section: Depression Antidepressants and Fracturesmentioning

confidence: 99%

See 1 more Smart Citation

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

220

178

View full text Add to dashboard Cite

Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. KeywordsAntidepressants; depression; falls; fear of falling; fractures One-third of community-dwelling seniors fall each year, with half of these individuals falling more than once. Ten percent of all falls result in a major injury, which can lead to institutionalization and death. 1 Falls often result in a fear of further falls, leading to fearrelated restriction of activities: this activity restriction has been associated with subsequent impairment in balance, mobility, and disability. 2,3 Send correspondence and reprint requests to Alastair

show abstract

Section: Depression Antidepressants and Fracturesmentioning

confidence: 99%

Section: Depression Antidepressants and Fracturesmentioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

220

178

View full text Add to dashboard Cite

show abstract

“…Comme tout bon médicament, les ISRS ne sont pas dépourvus d'effets secondaires. L'un d'entre eux est de provoquer une perte osseuse chez les patients traités au long cours, l'autre est d'augmenter l'appétit [16][17][18][19]. Ces observations cliniques suggèrent que la sérotonine d'origine cérébrale pouvait bien être un régulateur de la masse osseuse et de l'appétit.…”

Section: La Leptine Inhibe La Sérotonine Cérébraleunclassified

La double vie de la sérotonine ou quand la génétique découvre la physiologie

Oury

Karsenty

2010

Med Sci (Paris)

View full text Add to dashboard Cite

On peut proposer deux définitions, non exclusives et complémentaires, de la physiologie. La plus récente est l'étude intracellulaire, moléculaire et forcément réductrice des événements de signalisation qui déter-minent une fonction physiologique donnée. La seconde définition, plus classique, est l'étude des signaux extracellulaires, hormonaux ou neuronaux, à l'origine des grandes fonctions physiologiques. Cette dernière vision de la physiologie, imposant une étude chez l'animal entier, a été réactualisée par l'avènement de la géné-tique moléculaire chez la souris. En effet, la possibilité d'invalider un seul gène, si possible dans un seul type cellulaire, a permis de découvrir durant les vingt dernières années de nombreuses fonctions physiologiques dont l'existence même était insoupçonnée. Nous en citerons trois qui n'auraient sans doute pas pu être découvertes autrement : le rôle du tissu adipeux dans le contrôle de l'appétit [1, 2], la régulation de la masse osseuse par le cerveau [3-5] et la régulation du méta-bolisme énergétique par le squelette [6]. Ces récentes découvertes suggèrent que de nombreuses autres voies physiologiques restent encore insoupçonnées. La physiologie du squelette et les contraintes du réelL'importance d'une approche génétique pour comprendre la physiologie est parfaitement illustrée par l'étude des fonctions du squelette, un des derniers organes à apparaître durant l'évolution. Comme chaque organe, le squelette a un certain nombre de particularités qui définissent ce que peut être sa physiologie. Deux > Durant les vingt dernières années, l'émergence d'outils génétiques sophistiqués a permis d'approfondir notre connaissance d'un grand nombre de fonctions physiologiques et d'en découvrir de nouvelles. Ceci est parfaitement illustré par l'étude des fonctions physiologiques du squelette. Le constant remodelage osseux a un coût énergétique important qui nous a amenés à émettre l'hypothèse d'un contrôle endocrinien commun de la masse osseuse et du métabolisme énergétique, et de l'implication de la leptine, une hormone synthétisée dans les adipocytes et qui contrôle à la fois ces deux fonctions. Nous avons découvert que cette hormone agit en bloquant la synthèse et le relargage de la sérotonine céré-brale, un régulateur positif de l'accroissement de la masse osseuse et de l'appétit, révélant les bases moléculaires d'un contrôle commun central de la formation osseuse et de l'appétit. De manière inattendue, nous avons découvert ensuite que la sérotonine d'origine digestive influence elle aussi le remodelage osseux, mais de manière opposée à la sérotonine cérébrale. Il s'agit là sans doute d'un exemple unique : celui d'une molécule, la sérotonine, qui influence différemment une fonction donnée suivant son lieu de synthèse. Cela nous permet de proposer un traitement efficace et rationnel de l'ostéoporose via l'administration d'un inhibiteur de la biosynthèse de la sérotonine digestive dont nous avons montré qu'il pouvait à la fois prévenir l'apparition de l'ostéoporose et guérir ses conséquences...

show abstract

“…Ziere et al [2] reported that SSRIs and tricyclic antidepressants (TSAs) can cause fractures, especially in the bones of older patients, and fractures have appeared in the vertebrae of patients using SSRIs for long periods but not with TSAs.…”

Section: Dear Editormentioning

confidence: 99%

Long-term use of fluoxetine and multiple skeleton fractures

Ceylan

Maner

2010

Eur J Clin Pharmacol

View full text Add to dashboard Cite

Dear Editor:We report a 33-year-old female patient treated with fluoxetine for 8 years for depression.She had the first depression attack 14 years ago. She was treated with fluoxetine 20 mg/day and used that dose continuously for 5 years. After quitting the medication, her depression returned and fluoxetine was begun at 20 mg/day and increased to 40 mg/day and used at that dose for 3 months, than lowered to the original dose. At the end of 8 years of using fluoxetine 20 mg/day, three fractures occured within a short interval. The first fracture appeared on the right radius and distal third of the ulna. After 8 months, a second fracture at the left distal third of the spinal cruris emerged. One and a half years later, a fragmented fracture was seen at the collum chirurgicum and tuberculum majus in the proximal third of the right humerus. The patient was operated on four times due to those fractures. At the time of the fractures, there were no biochemical abnormalities other than slight elevations in the levels of LH and FSH. The bone densitometry was within normal limits. A poor densitometry rating was found (−1.5) only for the corpus femoris. Based on that finding,

show abstract

Selective Serotonin Reuptake Inhibiting Antidepressants Are Associated With an Increased Risk of Nonvertebral Fractures

Cited by 127 publications

References 47 publications

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

La double vie de la sérotonine ou quand la génétique découvre la physiologie

Long-term use of fluoxetine and multiple skeleton fractures

Contact Info

Product

Resources

About