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Depression and osteoporosis are common health problems in older women. SSRIs are first-line medications for treating depression, but their use might increase risk for fragility fractures. Investigators examined the association between SSRIs and fractures in a randomly selected, community-based cohort of 5008 men and women 50 years or older (71% women). Fracture-related risk factors and medication use were assessed at baseline and after 5 years, and BMD measurements of the lumbar spine and hip were taken at baseline. Participants completed yearly questionnaires to report fractures, and clinical fragility fractures were confirmed radiographically.
At baseline, 137 participants (83% women) were using SSRIs daily. SSRI users were more likely than nonusers to have depressive symptoms, a history of falls, and lower hip BMD. The risk for fragility fractures in daily SSRI users was twice that for nonusers, even after multivariate analysis adjusting for potential confounders such as personal health history and habits, demographics, medication history, and baseline hip BMD. The doubled risk persisted throughout the study period in patients who used SSRIs both at baseline and 5 years later.
Richards JB et al. Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med 2007 Jan 22; 167:188-94.
Comment
The investigators postulated that SSRIs could increase fracture risk by directly affecting bone physiology as well as by increasing the risk for falls due to syncope. If other studies confirm this association, the results suggest that SSRIs should be considered an independent risk for fracture in the evaluation of patients with, or at risk for, osteoporosis. Older women, particularly those using SSRIs, should be educated about strength and balance exercises as well as home safety to decrease the likelihood of falls.