Risk of nonvertebral fractures among elderly postmenopausal women using antidepressants

ObjectiveTo examine the association between antidepressants, including TCAs, SSRIs, and miscellaneous antidepressants and the risk of nonvertebral fractures among women with osteoporosis.Materials and methodsThis study was a post-hoc analysis of pooled data from two international, phase III, randomized, placebo-controlled, double-blind studies (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and TReatment Of Peripheral OSteoporosis [TROPOS]). A nested case‐control study was performed in the placebo treated population. Adjusted logistic regression models were used to estimate the risk of nonvertebral fracture associated with the use of antidepressants.ResultsAfter 3 years of follow-up, 391 nonvertebral fractures cases were identified and matched to 1955 controls. Compared with non-users of antidepressants, antidepressants use was associated with an increased risk of nonvertebral fractures (adjusted OR = 1.64; 95%CI, 1.03–2.62]). Particularly, there was a 2-fold risk increase (95%CI, 1.07–3.79) of nonvertebral fracture for current users of SSRIs and a 2.1-fold risk increase for subjects who were current users of TCAs (95%CI, 1.02–4.30). Among patients categorized as recent or past users, none of the classes of antidepressants were statistically associated with increased risk of nonvertebral fracture.ConclusionsOur findings confirm that both SSRIs and TCAs increase the risk of nonvertebral fracture in current users.

► Antidepressants use was associated with an increased risk of nonvertebral fractures.
► There was a 2-fold risk of nonvertebral fracture for current users of SSRIs and current users of TCAs
► The current use of antidepressants other than SSRIs or TCAs was not statistically associated with an increased risk of fractures
► For recent or past users, none of the classes of antidepressants were statistically associated with increased risk of nonvertebral fracture.