OT: Antidepressants Increase Fracture Risk for Older Patients

[Guest guest]

Antidepressants Increase Fracture Risk for Older Patients

 

 

By Crystal Phend, Staff Writer, MedPage Today

Reviewed by _Robert Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco _

(http://www.medpagetoday.com/reviewer.cfm?reviewerid=55)

 

January 22, 2007

 

 

 

MONTREAL, Jan. 22 -- Commonly used antidepressants may increase the risk of

osteoporotic fractures among patients 50 and older, researchers here found.

Action Points

* Explain to interested patients that the risk of fractures must be

weighed against the benefit of treating depression with the SSRI class of

antidepressants.

 

* Inform interested patients that the study focused on fracture risk

with SSRI medications rather than comparing different classes of

antidepressants.

 

Daily use of the selective serotonin reuptake inhibitors (SSRIs) doubled the

risk of a minimal-trauma fracture, reported David Goltzman, M.D., of Royal

Victoria Hospital and McGill University here, and colleagues, in the Jan. 22

issue of the Archives of Internal Medicine.

The prospective population-based study confirmed the link that had been

found in previous database studies t, which had limited ability to control for

confounding factors.

The researchers said these findings may have important public health

consequences because about 10% of older patients in the U.S. suffer from

depression.

SSRIs, because of their " presumed favorable adverse effect profile, " are

considered the first-line therapy for these patients.

Physicians should balance the risk of fracture against the benefits of

treating depression with SSRIs, Dr. Goltzman and colleagues wrote.

The researchers analyzed 137 patients ages 50 and older (average 65.1) who

reported daily SSRI use in the much larger Canadian Multicentre Osteoporosis

Study of community-dwelling adults. The SSRIs in the study-- those on the

market at baseline--included Celexa (citalopram), Prozac (fluoxetine), Luvox

(fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline).

Participants were sent yearly questionnaires for five years regarding

incident clinical fragility fractures, defined as clinically reported minimal

trauma fractures (such as falling from bed, chair, or standing height).

All fractures were radiographically confirmed, and tended to occur at

clinically relevant sites (40% forearm, 21% ankle and foot, 13% hip, 13% rib,

9%

femur, and 4% back).

Daily SSRI use was associated with substantially increased risk of fragility

fracture (hazard rate 2.1, 95% confidence interval 1.3 to 3.4) even after

adjusting for age, total hip bone mineral density, modified Charlson index,

prevalent vertebral deformity, prevalent fragility fractures at baseline, and

cumulative estrogen use.

The researchers also found a dose effect. A one unit increase in the daily

SSRI dose, effectively doubling the starting dose, increased the adjusted risk

of fragility fracture 1.5-fold (95% CI 1.1 to 2.1).

Participants with probable long-term use--those who reported daily SSRI use

at baseline and at the five-year follow-up though duration of use was

unknown--did not appear to have higher risk than the overall group who reported

taking antidepressants at baseline. The adjusted hazard rate for these patients

with recurrent use was 2.1 (95% CI 1.1 to 4.0).

Daily SSRI use was associated with 2.2-fold increased odds of falling in the

month before the baseline interview (95% CI 1.4 to 3.5). This relationship

was also dose dependent with 1.5-fold increased odds of falling for each

one-unit increase in daily SSRI dose (95% CI 1.1 to 2.0).

Controlling for the other potentially confounding factors, daily SSRI use

was associated with lower bone mineral density at the total hip (-4.0%

difference versus nonusers, 95% CI -6.6% to -1.4%) and the lumbar spine (-2.4%

difference versus nonusers, 95% CI -5.5% to 0.9%). This association was also

dose

dependent and similar for recurrent users.

Although lower bone mineral density and increased likelihood of falls would

increase the risk of fracture, both factors were controlled for in the

analysis and so cannot entirely explain the effect of SSRI use on fracture

risk,

the researchers said.

" Our results suggest that bone mineral density and falls may be affected

adversely by daily SSRI use but that fracture rates remain elevated despite

adjustment for these two risk factors, " they wrote, " indicating that other

pathways, such as impaired bone quality leading to reduced bone strength, may

be of

particular relevance. "

Other studies have shown that serotonin plays a potentially important role

in bone physiology by modulating the skeletal effects of parathyroid hormone

and mechanical stimulation, they said.

Depressive symptoms were also unlikely to have been responsible for the link

between fracture and SSRIs because the researchers found no association

between symptoms and fractures in univariate or multivariate regression models.

While the study focused on SSRI antidepressants, there was a small increase

in adjusted fracture risk for tricyclic antidepressants among the 162

participants reporting daily use of this class of antidepressants (HR 1.2, 95%

CI

0.7 to 2.2). However, " the wide 95% CI precludes any conclusions, " Dr. Goltzman

and colleagues said.

Participants in the study had " almost normal " dementia scores assessed with

the Mini-Mental State Examination (mean 29.1). The researchers said that

SSRIs may further elevate fractures among patients with dementia since dementia

is known to be an independent risk factor for fracture.

The researchers concluded that prospective, controlled trials will be needed

to confirm the findings.

The study was funded by the Canadian Institutes of Health Research, Merck

Frosst Canada, Eli Lilly Canada, Novartis Pharmaceuticals, the Alliance for

Better Bone Health (Sanofi-Aventis and Procter & Gamble Pharmaceuticals

Canada),

the Dairy Farmers of Canada, and the Arthritis Society. One of the authors

has received honoraria from Amgen; served on the advisory board of Eli Lilly;

and received grants from Proctor & Gamble, Sanofi-Aventis, Merck Frosst, and

Novartis.

_Additional Depression Coverage_

(http://www.medpagetoday.com/Psychiatry/Depression/)

 

 

 

[Guest guest]

And this from another article on this study:

" The drugs in question are called SSRIs or selective

serotonin reuptake inhibitors. These are generally the

favored treatment for depression in many patients and

their combined U.S. sales jumped 32 percent from 2000

to 2004, to more than $10.9 billion, the researchers

said. "

Do you believe this. SSRI use jumped 32% in four years.

And this is only one type of antidepressant.

Much of this increase is because we are giving these drugs to

children. They were approved for adults and have never been tested on

anyone under 19 years of age.

In the last two years, warnings have been placed on these drugs

because some children using them became more disturbed: ie suicidal

and some killed themselves. Only after these studies were published in

England did we admit this in the USA and put warnings on these drugs.

I saw a 2001 article listing the 25 most often prescribed drugs

in the USA.

4 are antidepressants and 2 are antipsychotics.

These doctors and big pharma and the FDA have one huge

conspiracy going. To drug as many people as is possible and create

illness where there is none.

Some people are depressed but nowhere near the numbers taking these

medications. These meds are highly addictive and very difficult to get

off. Many cost $150.-$300./month. in the USA.

In Europe, they use St. John's Wart for mild to moderate

depression. There are many other alt. treatments available

from counseling, exercise, acupuncture, Back Flower Remedies, Rife,

Audiotherapy and alt. products.

I have been using audiotherapy for 20+ years to get people off

these drugs or to help them cut back on dosage and frequency.

In my opinion, no medical doctor should be prescribing these

meds. If you are that depressed, go see a psychiatrist and a therapist

for counseling and use the therapy to get off these drugs.

These drugs should be used like a crutch when you break a leg.

When the leg heals, you throw it away.

Namaste,

David

 

 

 

In , Angls4Hope wrote:

>

>

> Antidepressants Increase Fracture Risk for Older Patients

>

>

> By Crystal Phend, Staff Writer, MedPage Today

> Reviewed by _Robert Jasmer, MD; Associate Clinical Professor of

Medicine,

> University of California, San Francisco _

> (http://www.medpagetoday.com/reviewer.cfm?reviewerid=55)

>

> January 22, 2007

>

>

>

> MONTREAL, Jan. 22 -- Commonly used antidepressants may increase the

risk of

> osteoporotic fractures among patients 50 and older, researchers

here found.

> Action Points

> * Explain to interested patients that the risk of fractures

must be

> weighed against the benefit of treating depression with the SSRI

class of

> antidepressants.

>

> * Inform interested patients that the study focused on

fracture risk

> with SSRI medications rather than comparing different classes of

> antidepressants.

>

> Daily use of the selective serotonin reuptake inhibitors (SSRIs)

doubled the

> risk of a minimal-trauma fracture, reported David Goltzman, M.D.,

of Royal

> Victoria Hospital and McGill University here, and colleagues, in

the Jan. 22

> issue of the Archives of Internal Medicine.

> The prospective population-based study confirmed the link that had

been

> found in previous database studies t, which had limited ability to

control for

> confounding factors.

> The researchers said these findings may have important public health

> consequences because about 10% of older patients in the U.S. suffer

from depression.

> SSRIs, because of their " presumed favorable adverse effect

profile, " are

> considered the first-line therapy for these patients.

> Physicians should balance the risk of fracture against the benefits of

> treating depression with SSRIs, Dr. Goltzman and colleagues wrote.

> The researchers analyzed 137 patients ages 50 and older (average

65.1) who

> reported daily SSRI use in the much larger Canadian Multicentre

Osteoporosis

> Study of community-dwelling adults. The SSRIs in the study-- those

on the

> market at baseline--included Celexa (citalopram), Prozac

(fluoxetine), Luvox

> (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline).

> Participants were sent yearly questionnaires for five years regarding

> incident clinical fragility fractures, defined as clinically

reported minimal

> trauma fractures (such as falling from bed, chair, or standing

height).

> All fractures were radiographically confirmed, and tended to occur at

> clinically relevant sites (40% forearm, 21% ankle and foot, 13%

hip, 13% rib, 9%

> femur, and 4% back).

> Daily SSRI use was associated with substantially increased risk of

fragility

> fracture (hazard rate 2.1, 95% confidence interval 1.3 to 3.4) even

after

> adjusting for age, total hip bone mineral density, modified

Charlson index,

> prevalent vertebral deformity, prevalent fragility fractures at

baseline, and

> cumulative estrogen use.

> The researchers also found a dose effect. A one unit increase in

the daily

> SSRI dose, effectively doubling the starting dose, increased the

adjusted risk

> of fragility fracture 1.5-fold (95% CI 1.1 to 2.1).

> Participants with probable long-term use--those who reported daily

SSRI use

> at baseline and at the five-year follow-up though duration of use was

> unknown--did not appear to have higher risk than the overall group

who reported

> taking antidepressants at baseline. The adjusted hazard rate for

these patients

> with recurrent use was 2.1 (95% CI 1.1 to 4.0).

> Daily SSRI use was associated with 2.2-fold increased odds of

falling in the

> month before the baseline interview (95% CI 1.4 to 3.5). This

relationship

> was also dose dependent with 1.5-fold increased odds of falling for

each

> one-unit increase in daily SSRI dose (95% CI 1.1 to 2.0).

> Controlling for the other potentially confounding factors, daily

SSRI use

> was associated with lower bone mineral density at the total hip (-4.0%

> difference versus nonusers, 95% CI -6.6% to -1.4%) and the lumbar

spine (-2.4%

> difference versus nonusers, 95% CI -5.5% to 0.9%). This association

was also dose

> dependent and similar for recurrent users.

> Although lower bone mineral density and increased likelihood of

falls would

> increase the risk of fracture, both factors were controlled for in the

> analysis and so cannot entirely explain the effect of SSRI use on

fracture risk,

> the researchers said.

> " Our results suggest that bone mineral density and falls may be

affected

> adversely by daily SSRI use but that fracture rates remain elevated

despite

> adjustment for these two risk factors, " they wrote, " indicating

that other

> pathways, such as impaired bone quality leading to reduced bone

strength, may be of

> particular relevance. "

> Other studies have shown that serotonin plays a potentially

important role

> in bone physiology by modulating the skeletal effects of

parathyroid hormone

> and mechanical stimulation, they said.

> Depressive symptoms were also unlikely to have been responsible for

the link

> between fracture and SSRIs because the researchers found no

association

> between symptoms and fractures in univariate or multivariate

regression models.

> While the study focused on SSRI antidepressants, there was a small

increase

> in adjusted fracture risk for tricyclic antidepressants among the 162

> participants reporting daily use of this class of antidepressants

(HR 1.2, 95% CI

> 0.7 to 2.2). However, " the wide 95% CI precludes any conclusions, "

Dr. Goltzman

> and colleagues said.

> Participants in the study had " almost normal " dementia scores

assessed with

> the Mini-Mental State Examination (mean 29.1). The researchers said

that

> SSRIs may further elevate fractures among patients with dementia

since dementia

> is known to be an independent risk factor for fracture.

> The researchers concluded that prospective, controlled trials will

be needed

> to confirm the findings.

> The study was funded by the Canadian Institutes of Health Research,

Merck

> Frosst Canada, Eli Lilly Canada, Novartis Pharmaceuticals, the

Alliance for

> Better Bone Health (Sanofi-Aventis and Procter & Gamble

Pharmaceuticals Canada),

> the Dairy Farmers of Canada, and the Arthritis Society. One of the

authors

> has received honoraria from Amgen; served on the advisory board of

Eli Lilly;

> and received grants from Proctor & Gamble, Sanofi-Aventis, Merck

Frosst, and

> Novartis.

> _Additional Depression Coverage_

> (http://www.medpagetoday.com/Psychiatry/Depression/)

>

>

>