Use of anti-depressants and the risk of fracture of the hip or femur

Brand, Manuel; Pouwels, S.; Samson, M; Staa, T P van; Thio, B.; Cooper, C; Leufkens, H.G.M.; Egberts, Toine C. G.; Verhaar, Harald J. J.; Vries, Frank de

doi:10.1007/s00198-009-0921-2

Cited by 7 publications

(18 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A reduced BMD in MS may be caused by the patient's immobility,7, 10 vitamin D deficiency,10 or use of GCs6, 7, 13 or antidepressants 23. Bone loss associated with physical inactivity can be explained by increased renal calcium losses, decreased gastrointestinal calcium absorption, secondary hyperparathyroidism, and increased bone turnover with depression of bone formation 7.…”

Section: Discussionmentioning

confidence: 99%

“…Potential confounders that were determined for a time‐dependent analysis included age, a history of chronic diseases (congestive heart failure, RA, cerebrovascular disease,19 inflammatory bowel disease, dementia, depression, epilepsy, and COPD20), as well as evidence of fatigue or visual disturbances 6 months before the start of a 30‐day interval. A prescription for orally or intravenously administered GCs,14, 21 statins,22 antiarrythmics, antidiabetics, antidepressants,23 antipsychotics,24 hypnotics/anxiolytics, asthma medication, anticonvulsants, hormone‐replacement therapy, vitamin D, levothyroxine, baclofen, or opioids (potencies equivalent to tramadol or higher) in the previous 6 months also were considered as potential confounders. The prescription of a medication was used as a proxy for use of that drug.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The risk of fracture in patients with multiple sclerosis: The UK general practice research

Bazelier

Staa

Uitdehaag

et al. 2011

Journal of Bone and Mineral Research

108

View full text Add to dashboard Cite

Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We conducted a population-based cohort study using data from the UK General Practice Research Database linked to the National Hospital Registry (1997Registry ( -2008. Incident MS patients (n ¼ 5565) were matched 1:6 by year of birth, sex, and practice with patients without MS (controls). Cox proportional-hazards models were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5-and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost threefold increased risk of hip fracture [HR ¼ 2.79, 95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR ¼ 1.35, 95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR ¼ 1.85, 95% CI 1.14-2.98) or antidepressants (HR ¼ 1.79, 95% CI 1.37-2.35) in the previous 6 months. Absolute fracture risks were low in younger MS patients but became substantial when patients were older than 60 years of age. It is concluded that MS is associated with an increased risk of fracture. Fracture risk assessment may be indicated in patients with MS, especially those prescribed GCs or antidepressants. ß

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The risk of fracture in patients with multiple sclerosis: The UK general practice research

Bazelier

Staa

Uitdehaag

et al. 2011

Journal of Bone and Mineral Research

108

View full text Add to dashboard Cite

show abstract

“…Antidepressants, notably selective serotonin reuptake inhibitors (SSRIs), have been associated with increased risk of femur or hip fracture . In observational studies, patients' exposure to SSRI medication may change over time; that is, physicians may stop SSRI therapy or switch to other classes of antidepressants because of adverse effects such as sexual dysfunction and drowsiness.…”

Section: Introductionmentioning

confidence: 99%

Methodological comparison of marginal structural model, time‐varying Cox regression, and propensity score methods: the example of antidepressant use and the risk of hip fracture

Ali

Belitser²,

Souverein³

et al. 2016

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“…activities of daily living), which may impair the validity of study results. For example, several observational studies indicated an association between antidepressants use (mainly tricyclic antidepressants and selective serotonin re‐uptake inhibitors) and the risk of hip fracture. However, results from these studies are heterogeneous for many reasons .…”

Section: Introductionmentioning

confidence: 99%

“…For example, several observational studies indicated an association between antidepressants use (mainly tricyclic antidepressants and selective serotonin re‐uptake inhibitors) and the risk of hip fracture. However, results from these studies are heterogeneous for many reasons . Among them, confounding by unmeasured patient characteristics such as frailty, severity of depression, and lifestyle factors (e.g.…”

Section: Introductionmentioning

confidence: 99%

Instrumental variables analysis using multiple databases: an example of antidepressant use and risk of hip fracture

Uddin

Boer

Gardarsdóttir

et al. 2016

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

Purpose Instrumental variable (IV) analysis can control for unmeasured confounding, yet it has not been widely used in pharmacoepidemiology. We aimed to assess the performance of IV analysis using different IVs in multiple databases in a study of antidepressant use and hip fracture. Methods Information on adults with at least one prescription of a selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant (TCA) during 2001-2009 was extracted from the THIN (UK), BIFAP (Spain), and Mondriaan (Netherlands) databases. IVs were created using the proportion of SSRI prescriptions per practice or using the one, five, or ten previous prescriptions by a physician. Data were analysed using conventional Cox regression and two-stage IV models. Results In the conventional analysis, SSRI (vs. TCA) was associated with an increased risk of hip fracture, which was consistently found across databases: the adjusted hazard ratio (HR) was approximately 1.35 for time-fixed and 1.50 to 2.49 for time-varying SSRI use, while the IV analysis based on the IVs that appeared to satisfy the IV assumptions showed conflicting results, e.g. the adjusted HRs ranged from 0.55 to 2.75 for time-fixed exposure. IVs for time-varying exposure violated at least one IV assumption and were therefore invalid.Conclusions This multiple database study shows that the performance of IV analysis varied across the databases for time-fixed and timevarying exposures and strongly depends on the definition of IVs. It remains challenging to obtain valid IVs in pharmacoepidemiological studies, particularly for time-varying exposure, and IV analysis should therefore be interpreted cautiously.

show abstract

Use of anti-depressants and the risk of fracture of the hip or femur

Abstract: The names of the second and third authors were given in the wrong order. The correct order of authors is as given above.

Cited by 7 publications

References 0 publications

The risk of fracture in patients with multiple sclerosis: The UK general practice research

The risk of fracture in patients with multiple sclerosis: The UK general practice research

Methodological comparison of marginal structural model, time‐varying Cox regression, and propensity score methods: the example of antidepressant use and the risk of hip fracture

Instrumental variables analysis using multiple databases: an example of antidepressant use and risk of hip fracture

Contact Info

Product

Resources

About