Use of Antidepressant Medications and Risk of Fracture in Older Women

  • Susan J. Diem
  • Terri L. Blackwell
  • Katie L. Stone
  • Jane A. Cauley
  • Teresa A. Hillier
  • Elizabeth M. Haney
  • Kristine E. Ensrud
  • for the Study of Osteoporotic Fractures Research Group
Original Research

DOI: 10.1007/s00223-011-9481-5

Cite this article as:
Diem, S.J., Blackwell, T.L., Stone, K.L. et al. Calcif Tissue Int (2011) 88: 476. doi:10.1007/s00223-011-9481-5

Abstract

Use of antidepressant medications has been associated with increased risk of fracture, but prior studies have been limited by incomplete control of confounders or a limited number of fractures. Use of antidepressant medications by 8,217 community-dwelling women aged 69 and older from a population-based prospective cohort study at four US clinical centers was assessed by interview at four examinations over a 10-year period, beginning in 1992–1994. Use was coded as a time-dependent variable. Incident fractures occurring after the initial medication assessment until July 2007 were confirmed by radiographic reports. Potential confounders were included in multivariable models and updated at each follow-up visit. Compared to nonusers of antidepressant medications, women using SSRIs experienced a higher risk of nonspine fracture in age-adjusted models (HR = 1.36, 95% CI 1.11–1.67) and in multivariable models controlling for potential confounders (HR = 1.30, 95% CI 1.04–1.62). SSRI use was not associated with an increased risk of first hip fracture (HR = 1.01, 95% CI 0.71–1.44) but was associated with an increased risk of wrist fracture (HR = 1.54, 95% CI 1.01–2.36). TCA use was associated with an increased risk of nonspine fracture in age-adjusted models, but in multivariable models this risk was attenuated. SSRI use was associated with a higher risk of any nonspine fracture, but not hip fracture, in this cohort of older women. TCA use was associated with a higher risk of nonspine fracture, but this association was in part explained by confounding factors.

Keywords

Selective serotonin reuptake inhibitor Tricyclic antidepressant Antidepressant Fracture Population study Depression 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Susan J. Diem
    • 1
  • Terri L. Blackwell
    • 2
  • Katie L. Stone
    • 2
  • Jane A. Cauley
    • 3
  • Teresa A. Hillier
    • 4
  • Elizabeth M. Haney
    • 5
  • Kristine E. Ensrud
    • 1
    • 6
  • for the Study of Osteoporotic Fractures Research Group
  1. 1.Division of Epidemiology & Community Health, Department of MedicineUniversity of MinnesotaMinneapolisUSA
  2. 2.California Pacific Medical Center Research InstituteSan FranciscoUSA
  3. 3.Division of EpidemiologyUniversity of PittsburghPittsburghUSA
  4. 4.Kaiser PermanentePortlandUSA
  5. 5.Department of MedicineOregon Health & Science UniversityPortlandUSA
  6. 6.Center for Chronic Disease Outcomes ResearchVeterans Affairs Medical CenterMinneapolisUSA