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Psychotropic medication, fractures, time-to-event analyses
Previous studies suggest that serotonin reuptake inhibitors (SSRIs) and/or serotonin/norepinephrine reuptake inhibitors (SNRIs) may be associated with falls and fractures. The objective of this work was to evaluate whether SSRI/SNRI use is associated with 10 - year risk for incident fracture in a population - based community cohort.
We used 10 - year follow - up CaMoS cohort data to compare fracture risk between participants, >50, exposed versus unexposed to SSRIs/SNRIs. Incident fragility fractures reported in the absence of major trauma were confirmed radiographically. Time - dependent variables were created to capture current use of SSRIs or SNRIs. Multivariable Cox proportional hazard regression was used to estimate the hazard ratio (HR) for fracture, adjusting for other medications (anxiolytics, other antidepressants, glucocorticoids, bisphosphonates, calcium and vitamin D supplements), and for potential confounders (age, sex, co - morbidity, history of falls, and bone mineral density [BMD] at baseline).
Among 6,645 subjects, 192 (2.9%) were using SSRIs or/and SNRIs at baseline and 583 (14.1%) used them at some time during follow - up. SSRI/SNRI users were more likely than non - users to be women and, at baseline, had more comorbidity, and higher use of anxiolytics and other antidepressants. There were 978 incident fractures (43 in the current SSRI/SNRI users) in 52,625.5 person - years. Controlling for all aforementioned covariates, current SSRI/SNRI use was associated with fragility fractures (HR: 1.67; 95% confidence interval: 1.33 - 2.14).
Current use of SSRI/SNRI was associated with an important, almost 70%, increase of risk of incident fragility fractures, even after controlling for important potential confounders.