Psychotropic Medications and the Risk of Fracture

Takkouche, Bahi; Montes-Martínez, Agustín; Gill, Sudeep S.; Etminan, Mahyar

doi:10.2165/00002018-200730020-00006

Cited by 197 publications

(164 citation statements)

References 72 publications

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“…A recent metanalysis to evaluate the risk of fractures in individuals using psychotropic drugs showed that benzodiazepines, antidepressants, non-barbituric anticonvulsants, barbituric anticonvulsants, anti-psychotics, hypnotics, and opioids have a higher risk of fractures. 32 Brazilian studies 33,34 with men older than 50 years indicated a positive and significant correlation between bone density and current and past physical activities, even after adjusting for age and BMI. A prospective cohort of 5,995 elderly men found a high prevalence of smoking (59%) and drinking (47%), and mean BMI similar to that of the present study (26.9 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 93%

O impacto da osteoporose no Brasil: dados regionais das fraturas em homens e mulheres adultos - The Brazilian Osteoporosis Study (BRAZOS)

Pinheiro¹,

Ciconelli²,

Jacques

et al. 2010

Rev. Bras. Reumatol.

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Objectives: The BRAZOS (The Brazilian Osteoporosis Study) study is the first epidemiological and population-based study carried out in a representative sample of Brazilian men and women, 40 years or older, with the objective of identifying the prevalence and main clinical risk factors (CRF) associated with low-impact fractures. This report shows the main results according to each region of the country. Patients and Methods: A total of 2,420 subjects (70% women) from 150 different cities in five geographic regions in Brazil, and from all different socio-economical classes were included in this study. Anthropometrical data, as well life style, previous fractures, nutritional status, physical activity, falls, and quality of life were evaluated by a quantitative individual survey. Low-impact fracture was defined as that resulting from a fall no greater than standing height of an individual. A P < 0.05 was considered significant. Results: Statistically significant differences in the prevalence of fractures among the five Brazilian regions according to gender or social class were not observed. However, in women, a higher incidence of fractures was observed in metropolitan areas than in rural areas, and a tendency for a higher frequency of fractures was observed in men from Northeastern states. Statistically significant differences among men from metropolitan areas or rural areas were not observed. Conclusions: Significant differences in the prevalence of low-impact fractures among the five different regions of Brazil were not observed, as well as its frequency or relevance of risk factors.

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Section: Discussionmentioning

confidence: 93%

O impacto da osteoporose no Brasil: dados regionais das fraturas em homens e mulheres adultos - The Brazilian Osteoporosis Study (BRAZOS)

Pinheiro¹,

Ciconelli²,

Jacques

et al. 2010

Rev. Bras. Reumatol.

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“…The majority have found that use of these medications, regardless of class (i.e., SSRI, TCA) is associated with increased risk of fracture [2]. However, most of these studies did not control for depression or depressive symptoms, and thus these analyses beg the question of whether the association between antidepressant use and fractures is due to confounding by indication.…”

Section: Fractures and Antidepressant Medicationsmentioning

confidence: 99%

“…Since that initial publication, much has been learned about the physiology of bone turnover and how those mechanisms interact with other systems of the body. Numerous studies have demonstrated an association between antidepressant medication use and osteoporotic fracture [2], and it has been suggested that depression may be an unrecognized risk factor for osteoporosis [3]. This article reviews the current evidence regarding comorbidity of depression, low bone mineral density, and fracture, and discusses the unresolved issues regarding these associations, including potential mediating pathways and the potential confounding influence of medications.…”

Section: Introductionmentioning

confidence: 99%

Depression and osteoporosis: epidemiology and potential mediating pathways

2007

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Introduction-There have been numerous studies examining the association between depression and bone mineral density (BMD), but the underlying nature of this relationship remains unclear. Independent of this association, there is a growing body of evidence that depression impacts the risk for fracture in older adults. This article reviews the current epidemiological evidence regarding comorbidity of depression, low bone mineral density, and fracture.

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“…6,7 Fracture is a serious potential consequence of falling, which among older adults can lead to significant morbidity, loss of independence, or death, especially in the case of hip fracture. 8,9 Most prior studies have found positive associations between the use of opioid analgesics and fractures in older adults, 5,[10][11][12] but evidence for an association between opioid use and falls has been inconsistent. 13,14 Importantly, chronic musculoskeletal pain is also associated with declines in physical function [14][15][16][17][18] and increased risk of falling.…”

Section: Introductionmentioning

confidence: 99%

Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain

et al. 2016

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BACKGROUND: Although older adults are disproportionately affected by painful musculoskeletal conditions and receive more opioid analgesics than persons in other age groups, insufficient evidence is available regarding opioid harms in this age group. OBJECTIVE: To examine longitudinal relationships between opioid use and falls, clinical fractures, and changes in physical performance. We hypothesized that opioid use would be associated with greater risks of falling and incident clinical fractures and greater declines in physical performance. DESIGN: We analyzed data from the Osteoporotic Fractures in Men Study (MrOS), a large prospective longitudinal cohort study. Participants completed baseline visits from 2000 to 2002 and were followed for 9.1 (SD 4.0) years. PARTICIPANTS: MrOS enrolled 5994 communitydwelling men ≥ 65 years of age. The present study included 2902 participants with back, hip, or knee pain most or all of the time at baseline. MAIN MEASURES: The exposure of interest was opioid use, defined at each visit as participant-reported daily or near-daily use of any opioid-containing analgesic. Among patients, 309 (13.4 %) reported opioid use at one or more visits. Participants were queried every 4 months about falls and fractures. Physical performance scores were derived from tests of grip strength, chair stands, gait speed, and dynamic balance. KEY RESULTS: In the main analysis, the adjusted risk of falling did not differ significantly between opioid use and non-use groups (RR 1.10, 95 % CI 0.99, 1.24). Similarly, adjusted rates of incident clinical fracture did not differ between groups (HR 1.13, 95 % CI 0.94, 1.36). Physical performance was worse at baseline for the opioid use group, but annualized change in physical performance scores did not differ between groups (−0.022, 95 % CI −0.138, 0.093). CONCLUSIONS: Additional research is needed to determine whether opioid use is a marker of risk or a cause of falls, fractures, and progressive impairment among older adults with persistent pain.

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Psychotropic Medications and the Risk of Fracture

Abstract: Globally, the increase in the risk of fractures among psychotropic drug users is moderate. Further research is needed, especially to examine high-risk populations and newer medications. Future studies should be prospective and emphasise control of confounding bias.

Cited by 197 publications

References 72 publications

O impacto da osteoporose no Brasil: dados regionais das fraturas em homens e mulheres adultos - The Brazilian Osteoporosis Study (BRAZOS)

O impacto da osteoporose no Brasil: dados regionais das fraturas em homens e mulheres adultos - The Brazilian Osteoporosis Study (BRAZOS)

Depression and osteoporosis: epidemiology and potential mediating pathways

Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain

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