Use of antidepressant medications has been associated with increased risk of fracture, but prior studies have been limited by incomplete control of confounders or a limited number of fractures. Use of antidepressant medications by 8,217 community-dwelling women aged 69 and older from a population-based prospective cohort study at four US clinical centers was assessed by interview at four examinations over a 10-year period, beginning in 1992-1994. Use was coded as a time-dependent variable. Incident fractures occurring after the initial medication assessment until July 2007 were confirmed by radiographic reports. Potential confounders were included in multivariable models and updated at each follow-up visit. Compared to nonusers of antidepressant medications, women using SSRIs experienced a higher risk of nonspine fracture in age-adjusted models (HR = 1.36, 95% CI 1.11-1.67) and in multivariable models controlling for potential confounders (HR = 1.30, 95% CI 1.04-1.62). SSRI use was not associated with an increased risk of first hip fracture (HR = 1.01, 95% CI 0.71-1.44) but was associated with an increased risk of wrist fracture (HR = 1.54, 95% CI 1.01-2.36). TCA use was associated with an increased risk of nonspine fracture in age-adjusted models, but in multivariable models this risk was attenuated. SSRI use was associated with a higher risk of any nonspine fracture, but not hip fracture, in this cohort of older women. TCA use was associated with a higher risk of nonspine fracture, but this association was in part explained by confounding factors.
Bibliographical noteFunding Information:
The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grant numbers: AG05407, AR35582, AG05394, AR35584, AR35583, AG005407, AG027576, AG005394, and AG027574. E. M. H. is supported by a career development award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23 AR051926). The funding agencies had no direct role in the conduct of the study; the collection, management, analyses, and interpretation of the data; or the preparation or approval of the manuscript.
Susan J. Diem, Katie L. Stone, Jane A. Cauley, Teresa A. Hillier, Elizabeth M. Haney, and Kristine E. Ensrud have received grant support from the NIH (and supporting agencies). Susan J. Diem has received grant support from Pfizer, Inc., and Eli Lilly and Co. Jane A. Cauley receives grant support from and serves as a consultant for Novartis.
- Population study
- Selective serotonin reuptake inhibitor
- Tricyclic antidepressant