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Elder Care News
Older Adults Double Their Risk of Some Fractures
with Daily Antidepressant
High rate of SSRI use among elderly persons in
particular
 January 23, 2007 Older adults, defined for this
study as 50 years and older, double their risk of "some fractures" with
the daily use of antidepressant medications known as selective serotonin
reuptake inhibitors (SSRIs), according to a report in the January 22,
2007 issue of Archives of Internal Medicine, one of the JAMA/Archives
journals.
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Elder Care News |
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Depression affects about 10 percent of primary care
patients in the United States, according to background information in
the article. The use of SSRIs for the treatment of depressive symptoms
is widespread due to the medications presumed favorable adverse effect
profile.
Past studies have found the use of these
antidepressants to be associated with an increased risk of clinical
fragility fracture (fractures due to falling from bed, chair or standing
height), but did not reliably examine such factors as falls and bone
mineral density, the authors note.
J. Brent Richards, M.D., of McGill University,
Montreal, Quebec, and colleagues evaluated 5,008 community-dwelling
adults 50 years and older who were followed up for over five years for
incident fractures.
Researchers examined the relationships between SSRI
use, bone mineral density (BMD) and falls. Participants who used the
medication at the beginning of the study and at year five were
considered to be recurrent users. BMD of the lower spine and hip were
measured at the beginning of the study.
Patients were then sent a yearly questionnaire to
determine if they had experienced clinical fragility fractures and all
reported fractures were confirmed radiographically. Other factors such
as demographic information, history of falls and medication use were all
assessed.
Daily use of SSRIs was reported by 137 participants
with an average age of 65.1 years. The researchers found that daily
SSRI use remained associated with a two-fold increased risk of incident
clinical fragility fracture even after adjustment for many potential
confounding variables.
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More About SSRI Drugs |
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Here are the SSRIs that have been approved by the
Food and Drug Administration specifically to treat depression, with
their generic or chemical names followed by available brand names in
parentheses:
● Citalopram (Celexa)
● Escitalopram (Lexapro)
● Fluoxetine (Prozac, Prozac Weekly)
● Paroxetine (Paxil, Paxil CR)
● Sertraline (Zoloft)
Some of these medications may also be used to
treat conditions other than depression.
>>
More about SSRIs from the Mayo Clinic - click
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These fractures occurred at the forearm (40
percent), ankle and foot (21 percent), hip (13 percent), rib (13
percent) femur (9 percent) and back (4 percent). Participants who used
SSRIs at the beginning of the study had similar increased risks of
fracture to those who used them at follow-up.
During the initial interview, the daily use of
SSRIs was associated with an increased risk of falling. The effect was
dose-dependent; doubling the daily dose of SSRIs increased the odds of
falling 1.5-fold during the previous month. Daily use of SSRIs was also
associated with a 4 percent decreased BMD at the total hip and a 2.4
percent decrease at the lumbar spine.
Our results suggest that BMD and falls may be
affected adversely by daily SSRI use but that fracture rates remain
elevated despite adjustment for these two risk factors, indicating that
other pathways, such as impaired bone quality leading to reduced bone
strength, may be of particular relevance, the authors conclude. In
light of the high rate of SSRI use among the general population, and
among elderly persons in particular, further studies that include
controlled prospective trials are needed to confirm our findings.
Editor's Note: The Canadian Multicentre
Osteoporosis Study was funded by the Canadian Institutes of Health
Research, Merck Frosst Canada, Ltd., Eli Lilly Canada Inc., Novartis
Pharmaceuticals Inc., The Alliance for Better Bone Health
(Sanofi-Aventis and Proctor & Gamble Pharmaceuticals Canada Inc.), The
Dairy Farmers of Canada and The Arthritis Society.
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