Abstract
AIM: Both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of fractures. The serotonin transporter (5-HTT) has been located in the bone and may play a role in bone physiology. We assessed the association between antidepressant drug use, categorized in a therapeutical-based way and on basis of their affinity for the 5-HTT, and the risk of both osteoporotic and non-osteoporotic fractures.
METHODS: A case-control study was conducted using the PHARMO RLS. Cases were patients with a first hospital admission for a fracture during the study period. Up to four controls were matched to each case on gender, age, geographical area, and index date.
RESULTS: We identified 16,717 cases, of whom 59.5% had an osteoporotic fracture, and 61,517 controls. Compared to no use, current use of SSRIs was associated with a statistically significant increased risk of osteoporotic fractures (OR 1.95, 95% CI 1.69-2.26), as was current use of TCAs and non-SSRI/non-TCA antidepressant drugs (ORs 1.37, 95% CI 1.16-1.63 and 1.40, 95% CI 1.06-1.85, respectively). The risk of an osteoporotic fracture was statistically significantly higher for antidepressants with a high affinity for the 5-HTT (OR 1.86, 95% CI 1.63-2.13) compared to antidepressants with a medium or low affinity (OR 1.43, 95% CI 1.19-1.72 (medium) and OR 1.32 95% CI 0.98-1.79 (low) (p<0.05 for trend). The risk of non-osteoporotic fractures did not show the same trend.
CONCLUSIONS: The extent of affinity for the 5-HTT may contribute to the increased risk of osteoporotic fractures related to antidepressant drug use. The pharmacological mechanism-based classification could to be an appropriate alternative for traditional classification to study the association between the use of antidepressants and the risk of fractures.
Original language | English |
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Pages (from-to) | 604-9 |
Number of pages | 6 |
Journal | Bone |
Volume | 47 |
Issue number | 3 |
DOIs | |
Publication status | Published - Sept 2010 |
Externally published | Yes |
Keywords
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antidepressive Agents/adverse effects
- Antidepressive Agents, Tricyclic/adverse effects
- Case-Control Studies
- Depression/drug therapy
- Fractures, Bone/chemically induced
- Humans
- Middle Aged
- Osteoporotic Fractures/chemically induced
- Risk Factors
- Serotonin Plasma Membrane Transport Proteins/metabolism
- Serotonin Uptake Inhibitors/adverse effects
- Young Adult