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

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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 + .

Methods

We used data from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective randomly selected population-based community cohort; our analyses focused on subjects aged 50+. Time to event methodology was used to assess the association between SSRI/SNRI use, modeled time-dependently, and fragility fracture.

Results

Among 6,645 subjects, 192 (2.9 %) were using SSRIs or/and SNRIs at baseline. During the 10-year study period, 978 (14.7 %) participants experienced at least one fragility fracture. In our main analysis, SSRI/SNRI use was associated with increased risk of fragility fracture (hazard ratio (HR), 1.88; 95 % confidence intervals (CI), 1.48–2.39). After controlling for multiple risk factors, including Charlson score, previous falls, and bone mineral density hip and lumbar bone density, the adjusted HR for current SSRI/SNRI use remained elevated (HR, 1.68; 95 % CI, 1.32–2.14).

Conclusions

Our results lend additional support to an association between SSRI/SNRI use and fragility fractures. Given the high prevalence of antidepressants use, and the impact of fractures on health, our findings may have a significant clinical impact.

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Conflicts of interest

Lisa-Ann Fraser has been on the speaker’s bureau for Amgen. Jonathan D. Adachi has been a consultant/speaker for Amgen, Eli Lilly, Merck, Novartis, and Warner Chilcot, and has conducted clinical trials for Amgen, Eli Lilly, Merck, and Novartis. David Goltzman has been an advisory board member or consultant for Amgen, Eli Lilly, Merck Frosst, and Novartis. William Leslie has received speaker fees from Amgen, Eli Lilly, and Novartis and research grants from Amgen and Genzyme.

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Authors and Affiliations

  1. McGill University, Montreal, Canada

    C. Moura, S. Bernatsky, M. Abrahamowicz, D. Goltzman & E. Rahme

  2. McMaster University, Hamilton, Canada

    A. Papaioannou, J. Adachi, G. Ioannidis & L. Pickard

  3. Université Laval, Québec, Canada

    L. Bessette

  4. University of British Columbia, Vancouver, Canada

    J. Prior

  5. University of Toronto, Toronto, Canada

    N. Kreiger

  6. Queen’s University, Kingston, Canada

    T. Towheed

  7. University of Manitoba, Winnipeg, Canada

    W. D. Leslie

  8. Dalhousie University, Halifax, Canada

    S. Kaiser

  9. Western University, London, Canada

    L.-A. Fraser

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  1. C. Moura
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Correspondence to C. Moura.

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Moura, C., Bernatsky, S., Abrahamowicz, M. et al. Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS). Osteoporos Int 25, 1473–1481 (2014). https://doi.org/10.1007/s00198-014-2649-x

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  • DOI: https://doi.org/10.1007/s00198-014-2649-x

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