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Anti-Depressants increase bone fractures in older women.

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Do anti-depressants increase bone fractures?  Evidence from a new study says yes.  Anti-depressants in the SSRI family have been shown to increase risk of bone fracture before. The new study, hot in Google News, looked at women who were new users without a diagnosis of depression (and presumably prescribed SSRIs for menopausal symptoms) and their risk of bone fracture.  SSRIs are sometimes used to treat menopausal symptoms such as night sweats, hot flashes and mood changes.  Their use has increased since estrogen replacement therapy fell into disfavor.    This study is different and important because:

 

  • Women who are using SSRIs to treat menopausal symptoms are often prescribed doses lower than those used to treat women suffering from depression.
  • We didn’t know if low-dose SSRIs would increase fracture risk
  • Data was available for very large numbers of women (more than 100,000 for each group).  This makes for some pretty reliable conclusions.

Study Structure

Subjects were between the ages of 40 and 64 who had not been diagnosed with depression or other mental disorder.  They were compared with a similar group of women who were taking proton pump inhibitors or H2 antagonists.  These are drugs often used to treat GERD (Gastroesophgeal reflux disease).  They may also increase risk of bone fracture because of their ability to interfere with calcium absorption . . . but the risk appears to be very small.

Study results

After six months of SSRI use, fracture risk was greater than it was among women who did not use SSSRIs.   The difference between the two groups decreased slightly over time, but was still significant after 5 years.  So yes, it looks like anti-depressants increase bone fractures.  At least SSRI anti-depressants.

Conclusions and further thoughts

This may be the first study to show an increased risk of fracture among peri-menopausal women using SSRIs to treat menopausal symptoms.   The study’s authors suggest that use of SSRIs to treat menopause be limited to shorter durations.  Researchers were not able to look at the effects of different doses.  (The actual doses used were not available). Or differences according to type of SSRIs.

Other things to consider

Bone density and fracture risk are dependent on many factors that were not available to the researchers.  Nothing was known about the women’s exercise habits or diet.  Bone building exercise might offset any bone weakness potentially caused by SSRIs.  A good diet and vitamin D might as well.  More research would be needed to understand risks from SSRIs and how they might be controlled.

The two groups were chosen for study not because they were ideal for them, but because the data were available.  It would be nice to have a study that looked at SSRIs, untreated depression, untreated menopause, bone density, fracture risk, and diet.  But studies are expensive.  We are currently in a period where the proportion of funds we devote to research has fallen severely.  According to Reuter’s journalist Sharon Begley:  Government spending on science is the lowest it’s been since WWII, and it’s holding back potentially life-saving advances.  You can write your congressman and tell him or her that research is important.    We all benefit from research.

Andrea B. Kirk, PhD

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Ito T, & Jensen RT (2010). Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Current gastroenterology reports, 12 (6), 448-57 PMID: 20882439

Sheu YH, Lanteigne A, Stürmer T, Pate V, Azrael D, & Miller M (2015). SSRI use and risk of fractures among perimenopausal women without mental disorders. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention PMID: 26113668