Widely Used Antidepressants Linked to Bone Fractures in Menopausal Women
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Friday, July 03, 2015 02:05 PM
Quick Brief:  Women taking SSRI medications are up to 76% more likely to break a bone regardless of the reason for taking the SSRI.


Women taking selective serotonin reuptake inhibitors (SSRIs) to treat menopausal symptoms are up to 76% more likely to break a bone, according to an observational study.

SSRI use for nonpsychiatric conditions such as VMS, irritable bowel syndrome, and premature ejaculation has increased to the point that antidepressants are the third most commonly prescribed class of drug in the U.S., with much of that growth attributable to non-psychiatrists prescribing to patients without a psychiatric disorder, the investigators noted.

The increased risk persists for at least 5 years following initiation of SSRI treatment, suggesting that shortening treatment could reduce the risk, said the senior investigator. 

"To our knowledge, the current study is the first to examine whether SSRI use is related to fracture risks in a population of middle-aged women without known psychiatric disorders, a demographic for which, given the recent FDA approval of paroxetine for the treatment of VMS (vasomotor menopausal symptoms), SSRI use may increase," the investigators wrote.



The study included more than 137,000 women ages 40 to 64 with no mental health issues who started SSRIs between 1998 and 2010. 

The investigators compared this group with more than 236,000 women of the same age prescribed H2 antagonists or proton pump inhibitors (PPIs), typically used to treat indigestion, over the same time frame.  The investigators reported that after one year of treatment, the women on SSRIs were 76% more likely to suffer a fracture.  The risk persisted at year 2 of the study and at year 5, the final year of the study.

"This finding is consistent with results from studies involving patients with mental health disorders," the investigators wrote. "The sustained higher risk among SSRI users is also consistent with the biological hypothesis that fractures associated with SSRI use can be at least partially attributed to antidepressant-related modulation of bone homeostasis in favor of osteoclastic activity, which may result in lower bone mineral density and higher risks of fractures."

"The clinical implication of our finding is that treating menopausal symptoms with SSRIs at doses customarily used to treat depression is associated with higher risks of fractures -- an effect that first became evident several months after beginning treatment and, importantly, persisted over the 5-year study period."

Source:  http://www.medpagetoday.com/Endocrinology/Menopause/52321