Fractures in users of antidepressants and anxiolytics and sedatives effects of age and dose

Abstract

Aim-To study the effects of age and dose of selective serotonin reuptake inhibitors (SSRI), trycyclic antidepressants (TCA) and anxiolytics/sedatives on fracture risk. Subjects and methods-Case control study. From the Danish National Health Service, we identified 124,655 fracture cases and 373,962 age-and gender-matched controls. Crude odds ratios (OR) were estimated, and propensity score adjustment was used to minimize confounding by indication. Results-A higher risk of fractures was associated with an increasing dose of anxiolytics and sedatives; the highest excess risk was present in the age stratum below 40 years of age (p<0.01), and thereafter the excess risk of fractures declined with age. For SSRI, a growing excess risk of fractures was seen with both increasing dose and age. Regarding TCA, no particular trend with age was present. However, an increasing risk of fractures was associated with increasing TCA dose in the age group above 60 years. Finally, for other antidepressants no particular trend with age or dose was observed. In our data, a hospital diagnosis of depression or manic-depression was associated with fewer fractures. Conclusion-Caution should be shown upon prescription of SSRI to older subjects. A hospital diagnosis of depression or manic-depression and thus potentially more severe disease was not a risk factor for fractures.

Selective serotonin reuptake inhibitor and selective serotonin and norepinephrine reuptake inhibitor use and risk of fractures in adults: A systematic review and meta‐analysis

“…In the 11 case‐control studies, the numbers of case and control subjects ranged from 34 to 14 958 and from 412 to 373 962, respectively. In the 22 cohort studies, the numbers of participants ranged from 18 to 906 422 and the mean follow‐up period from 6 months to 10 years .…”

“…11,18,19,31,[40][41][42][43][44][45][46][47][48][49][50][51][52] The studies we found were published between 1998 37 and 2016, 19,[42][43][44]49 with 11 studies since 2013. 11,19,40,41,[43][44][45][46]48,49,52 Two studies were reported across multiple articles and each was treated as a single distinct study: Vestergaard et al 21,53,54 and Souverein et al 49,55,56 One study reported results from both a cohort 49,55 and a nested case-control analysis. 49,56 Estimates of effect size were very similar, but for meta-analyses where both sets of results were available, we kept those from the cohort analysis, as precision was higher, and dropped the case-control results.…”

Drug burden index to define the burden of medicines in older adults with intellectual disabilities: An observational cross‐sectional study

“…Lower scores indicated poorer physical function. Barthel index scores were categorized as per Wade and Collin [52] classifications: total dependence (0-4), severe dependence (5)(6)(7)(8)(9)(10)(11)(12), moderate dependence (13-18), mild dependence (19) and total independence (20).…”

SSRI use and risk of fractures among perimenopausal women without mental disorders

“…Third, we were not able to analyse the relationship between different doses of SSRIs and the risk of fractures, since there was little variation in the dose prescribed to the vast majority of our patients (and most were prescribed doses similar to those recommended for the treatment of depression). A recent population-based case–control study in Denmark suggests that fracture risk depends on average daily dose, but since average daily dose and cumulative dose were not disentangled, it is not clear whether daily dose is an independent predictor of fracture risk beyond its contribution to cumulative dose 35. Lastly, although we achieve good balance across known confounders, unmeasured confounding may still exist.…”