Long- and short-term SSRI use contributes to increased hip fracture risk

Treatment with selective serotonin reuptake inhibitors (SSRIs) in the short and long term appears to bear an increased risk of hip fracture, according to a recent study.

The case-control study used data from the US Renal Data System and included 4,912 maintenance haemodialysis patients with hip fracture and 49,120 nonfracture controls. All participants had >1 year of Medicare parts A and B coverage and >3 years of part D coverage.

During the 3-year part D coverage period, SSRI exposure was characterized as any (≥1 prescription filled), low, moderate and high use (<20 percent, 20 to <80 percent, and ≥80 percent of days covered by filled prescriptions, respectively).

On conditional logistic regression analysis, SSRI use conferred a 25-percent increase in hip fracture risk (adjusted odds ratio [OR], 1.25, 95 percent confidence interval [CI], 1.17–1.35). Risk estimates for fracture associated with any, low, moderate and high SSRI use were as follows: 1.25 (95 percent CI, 1.17–1.35), 1.20 (95 percent CI, 1.08–1.32), 1.31 (95 percent CI, 1.18–1.43) and 1.26 (95 percent CI, 1.12–1.41), respectively.

Researchers performed a separate examination of new short-term SSRI exposure in cases and controls with >18 months of part D coverage and no prior antidepressant use for 1 year. Results revealed a similar pattern of association with hip fracture risk (adjusted OR, 1.43, 95 percent CI, 1.23–1.67).

“The stronger association with new short-term use may suggest an acute mechanism potentially related to falls,” the researchers explained.

The study was limited by the inability to capture and account for biomarkers of mineral bone disorder.