Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS)

Abstract

Summary-We used data from a large, prospective Canadian cohort to assess the association between selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) and fracture. We found an increased risk of fractures in individuals who used SSRI or SNRI, even after controlling for multiple risk factors.Introduction-Previous studies have suggested an association between SSRIs and increasing risk of fragility fractures. However, the majority of these studies were not long-term analyses or were performed using administrative data and, thus, could not fully control for potential confounders. We sought to determine whether the use of SSRIs and SNRIs is associated with increased risk of fragility fracture, in adults aged 50+.

Negative effect of serotonin–norepinephrine reuptake inhibitor therapy on rat bone tissue after orchidectomy

“…The mechanism of action of different classes of antidepressants appears to produce different skeletal effects: several rodent and human observational studies have reported negative skeletal effects with serotonergic antidepressants. There have been several recent studies linking SSRI/SNRI drugs to increased fragility in humans, which are consistent with our results (Warden et al, 2010(Warden et al, , 2008Bonnet et al, 2007;Lanteigne et al 2015;Moura et al, 2014).…”

“…The mechanism by which antidepressants impact bone health appears to be primarily via serotonergic pathways (Shea et al, 2013). Functional 5-hydroxytryptamine (5-HT) transporters and receptors are present in osteoblasts, osteocytes and osteoclasts, and stimulation of these receptors influences bone cell activities (Moura et al, 2014). The mechanism of action of different classes of antidepressants appears to produce different skeletal effects: several rodent and human observational studies have reported negative skeletal effects with serotonergic antidepressants.…”

Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort

“…A higher risk of fractures has previously been reported in SSRI users, with a duration-and dosedependent effect; the higher the doses, the longer the use and the higher the risk [10,11,14,42,43]. However, most studies using administrative data, could not fully control for important confounders such as osteoporosis and related factors, e.g., use of anti-osteoporosis drugs and supplements (e.g., calcium, vitamin D or hormone therapy in women) and smoking.…”

Medication-induced osteoporosis: screening and treatment strategies

“…Dose and duration of SSRIs also contribute to fracture risk, with both an early increased risk (<6 weeks) and a late risk associated with prolonged use for more than 3-5 years [Richards et al 2007;Eom et al 2012]. A recently published large 10-year longitudinal cohort study [Moura et al 2014] examined fracture risk in SSRI and SNRI users over the age of 50. They found SSRI and NSRI use increased fragility fractures with a hazard ratio (HR) of 1.88 (95% CI 1.48-2.39).…”