<p>Individual Antidepressants and the Risk of Fractures in Older Adults: A New User Active Comparator Study</p>

Abstract

Objective: To determine the risk of hip-pelvis and other non-vertebral fractures in older adults using antidepressants (ADs). Methods: We conducted a case-control study nested in a cohort of new users of ADs aged ≥65 years without prior hip-pelvis or other non-vertebral fractures, identified in the German Pharmacoepidemiological Research Database (GePaRD) during 2005-2014. Cases were patients first hospitalized for hip-pelvis or other non-vertebral fractures. Up to 100 controls per case were selected using incidence density sampling. AD use was ascertained at index date (ID) based on the supply of last dispensing. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression with current users of mirtazapine as reference (active comparator). Results: A total of 39,853 cases of hip-pelvis fracture (80% women, median age 81 years) and 31,577 cases of other fractures (84% women, median age 79 years) were matched to >3 million controls. For hip-pelvis fracture, aORs in current users were about 1.3 with little variation between individual ADs, ranging from 1.33 for citalopram (95% CI 1.27-1.39) to 1.28 for amitriptyline (1.21-1.35). For other fractures, the aORs were highest in current users of citalopram (1.50; 1.42-1.58) and duloxetine (1.54; 1.39-1.71) and lowest for amitriptyline (1.18; 1.11-1.26) and trimipramine (1.16; 1.03-1.29). For all examined ADs, the aORs were higher for other fractures than for hip-pelvis fracture. Conclusion: The risk of fractures varies between ADs, but for most agents is higher than the risk for mirtazapine. When treating older adults with ADs, prescribers should carefully consider the risk profile of individual ADs regarding fractures, which are a major health problem in this population.

Associations of poor sleep quality, chronic pain and depressive symptoms with frailty in older patients: is there a sex difference?

“…Apart from polypharmacy, several studies have shown that taking sedative-hypnotic drugs is significantly associated with poor physical function, poor appetite and frailty [ 46 – 48 ]. Antidepressants, as one of the important pharmacological treatment options for clinically diagnosed depressive and anxiety disorders, are associated with frailty, which may increase the risk of adverse effects [ 49 ], falls [ 50 ], and fractures [ 51 ]. Thus, our study excluded patients with clinically diagnosed depressive or anxiety disorders who were taking antidepressants in order to avoid confounding the observed associations.…”

Use of combined oral contraceptives and risk of venous thromboembolism in young women: a nested case–control analysis using German claims data

“…Diagnoses in GePaRD are coded according to the International Classification of Diseases, 10th revision, German modification (ICD-10-GM). 3 The suitability of GePaRD for pharmacoepidemiological research has been demonstrated by various types of pharmacoepidemiological studies investigating the risks of medications, [4][5][6][7][8] including a study on the risk of VTE in cancer patients treated with epoetins or blood transfusions. 9 During the study period (2005-2017), COCs were reimbursable in Germany only up to the 20th birthday (i.e.…”

The utility of the self‐controlled study design for pharmacoepidemiological studies without an active comparator medication using a medical information database: An application to assess the risk of varenicline on cardiovascular outcomes

“…4 Therefore, the use of ACs is a standard method in recent pharmacoepidemiological studies based on medical information databases. [5][6][7][8][9][10] However, the AC study design is not optimal when comparing the risk of medication use on an outcome with the risk of its non-use. Furthermore, it is difficult to identify a suitable AC when the medicine of interest is predominantly administered for a specific indication.…”

“…A study that included AC users rather than non‐users as the control group demonstrated that the distributions of risk factors among the groups being compared yielded similar results for measured and unmeasured factors 4 . Therefore, the use of ACs is a standard method in recent pharmacoepidemiological studies based on medical information databases 5–10 …”