Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people

Liu, Barbara; Anderson, Geoff; Mittmann, Nicole; To, Teresa; Axcell, Tami; Shear, Neil H.

doi:10.1016/s0140-6736(97)09528-7

Cited by 341 publications

(229 citation statements)

References 25 publications

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“…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).…”

Section: Depression Antidepressants and Fracturesmentioning

confidence: 78%

“…59 This pattern is in contrast to the risk of fractures with tricyclic antidepressants, which is highest with a new prescription, but decreases significantly with continuous use. 56 Older adults are thus at highest risk for falls and fractures shortly after starting an SSRI antidepressant but break bones at a higher rate throughout their treatment. The role of serotonin in bone metabolism may be a mechanism for this long-term association between fractures and SSRI use.…”

Section: Depression Antidepressants and Fracturesmentioning

confidence: 99%

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

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

212

178

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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

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Section: Depression Antidepressants and Fracturesmentioning

confidence: 78%

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

212

178

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“…Demographic variables included age at study entry, sex, and neighborhood income quintile based on census data for their postal code (26). Medications (any prescription within 1 year of index date) included estrogen (in women), nitrates, hydroxymethylglutaryl-CoA reductase inhibitors (statins), thiazide diuretics, inhaled corticosteroids, anticonvulsants, bisphosphonates, and a composite category of drugs that may promote falls such as ␤-blockers, sedatives, tranquilizers, antidepressants, antiparkinsonian drugs, and opiates (at least one prescription from this category versus none) (23).…”

Section: Primary Outcome and Follow-upmentioning

confidence: 99%

The Risk of Hip Fractures in Older Individuals With Diabetes

et al. 2007

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OBJECTIVE -Compared with men and women without diabetes, individuals with type 2 diabetes have higher bone mineral density (BMD). However, they may still be at increased risk for hip fractures. Using population-based Ontario health care data, we compared the risk of hip fractures among men and women with and without diabetes.RESEARCH DESIGN AND METHODS -Using a retrospective cohort design, we identified Ontario residents aged Ն66 years with diabetes from a validated registry from 1994 to 1995 (n ϭ 197,412) and followed them for their first hip fracture until 31 March 2003 (mean 6.1-year follow-up). Hip fracture rates were compared with those of age-matched Ontario residents without diabetes (n ϭ 401,400), and results were stratified by sex and adjusted for age and other covariates.RESULTS -Compared with individuals without diabetes, individuals with diabetes had greater comorbidity, were less likely to have had a BMD test, and were more likely to be taking medications that increase risk of falling and decrease BMD. After adjusting for these differences and age, we found that diabetes increased fracture risk in both men (hazard ratio 1.18 [95% CI 1.12-1.24], P Ͻ 0.0001) and women (1.11 [1.08 -1.15], P Ͻ 0.0001).CONCLUSIONS -Men and women with diabetes have a higher risk of hip fractures compared with individuals without diabetes. Further research to elucidate the mechanisms underlying this increased risk of fracture is needed, as well as increased attention to fracture prevention strategies in patients with diabetes. Diabetes Care 30:835-841, 2007O steoporotic fractures, such as hip and vertebral fractures, are a major source of morbidity and mortality for both men and women. In the 1st year after a hip fracture, there is a 20% increase in mortality, and an estimated 50% of women who sustain a hip fracture do not return to their previous level of function (1).An association between diabetes and hip fractures is becoming increasingly recognized. Both cross-sectional and prospective studies have shown that type 1 diabetes is associated with a decrease in bone mineral density (BMD) (2,3) and an increased risk of osteoporotic hip and other fractures (2,4 -7). In contrast, studies in patients with type 2 diabetes have demonstrated that these patients have higher BMD, probably due to increased body weight (8 -10), but have found inconsistent associations between type 2 diabetes and fractures. Some studies have shown no association (11), whereas other cross-sectional studies have demonstrated a decreased risk of fractures in this population (9,12). However, prospective studies have demonstrated that individuals with type 2 diabetes have an increased risk of osteoporotic fractures, particularly of the hip, despite having higher BMD (4 -6,13-16).Most of these findings have been documented in women (5,6,15). With respect to type 2 diabetes and fracture in men, studies either did not find an association (4,5) or did not specifically examine fracture risk by sex (14,16). Prior studies are also limited by modest sample sizes ...

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“…In contrast to our findings, a number of case-control studies using automated data have reported increased risk of hip fracture with antidepressant use. [41][42][43][44][45][46] This study design can be more vulnerable to bias owing to unmeasured covariates. 47 One cohort study has also reported a 65% increase risk of hip fracture with antidepressant therapy.…”

Section: Fracturementioning

confidence: 99%