Selective serotonin reuptake inhibitor treatment and risk of fractures: Ameta-analysis of cohort and case-control studies

Q. Wu, A. F. Bencaz, J. G. Hentz, M. D. Crowell

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Summary Studies on use of selective serotonin reuptake inhibitors (SSRIs) and risk of fracture have yielded inconsistent results. This meta-analysis, which pooled results from 13 qualifying cohort and case-control studies, found that SSRIs were associated with a significantly increased risk of fractures. Introduction This study was conducted to assess whether people who take SSRIs are at an increased risk of fracture. Methods We conducted a meta-analysis of observational studies. Relevant studies published by February 2010 were identified through literature searches using MEDLINE (from 1966), EMBASE (from 1988), PsycINFO (from 1806), and manual searching of reference lists. Only cohort or case-control studies that examined the association of SSRIs and risk of fracture and bone loss were included. Data were abstracted independently by two investigators using a standardized protocol; disagreements were resolved by consensus. Random effects models were used for pooled analysis due to heterogeneity in the studies. Results Thirteen studies met inclusion criteria. Overall, SSRI use was associated with a significantly increased risk of fracture (relative risk, RR, 1.72; 95% CI [1.51, 1.95]; P<0.001). An increased fracture risk associated with SSRIs also was observed in the three studies that adjusted for bone mineral density (RR, 1.70; 95% CI [1.28, 2.25]; P<0.001) and in the four studies that adjusted for depression (RR 1.74; 95% CI [1.28, 2.36]; P<0.001). SSRI use was not associated with bone loss in the two cohort studies of women (P=0.29). The overall association between SSRI use and fracture risk was weaker (RR, 1.40; 95% CI [1.22, 1.61]), though still significant (P<0.001) in analyses that accounted for apparent publication bias. Conclusions Use of SSRIs is associated with increased risk of fracture. The SSRIs may exert an increased risk of fracture independent of depression and bone mineral density.

Original languageEnglish (US)
Pages (from-to)365-375
Number of pages11
JournalOsteoporosis International
Volume23
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Serotonin Uptake Inhibitors
Case-Control Studies
Cohort Studies
Bone Density
Meta-Analysis
Publication Bias
Bone Fractures
MEDLINE
Observational Studies
Research Personnel
Bone and Bones

Keywords

  • Antidepressant
  • Bone fractures
  • Bone mineral density
  • Depression . Osteoporosis
  • Serotonin reuptake inhibitors

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Selective serotonin reuptake inhibitor treatment and risk of fractures : Ameta-analysis of cohort and case-control studies. / Wu, Q.; Bencaz, A. F.; Hentz, J. G.; Crowell, M. D.

In: Osteoporosis International, Vol. 23, No. 1, 01.2012, p. 365-375.

Research output: Contribution to journalArticle

Wu, Q. ; Bencaz, A. F. ; Hentz, J. G. ; Crowell, M. D. / Selective serotonin reuptake inhibitor treatment and risk of fractures : Ameta-analysis of cohort and case-control studies. In: Osteoporosis International. 2012 ; Vol. 23, No. 1. pp. 365-375.
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abstract = "Summary Studies on use of selective serotonin reuptake inhibitors (SSRIs) and risk of fracture have yielded inconsistent results. This meta-analysis, which pooled results from 13 qualifying cohort and case-control studies, found that SSRIs were associated with a significantly increased risk of fractures. Introduction This study was conducted to assess whether people who take SSRIs are at an increased risk of fracture. Methods We conducted a meta-analysis of observational studies. Relevant studies published by February 2010 were identified through literature searches using MEDLINE (from 1966), EMBASE (from 1988), PsycINFO (from 1806), and manual searching of reference lists. Only cohort or case-control studies that examined the association of SSRIs and risk of fracture and bone loss were included. Data were abstracted independently by two investigators using a standardized protocol; disagreements were resolved by consensus. Random effects models were used for pooled analysis due to heterogeneity in the studies. Results Thirteen studies met inclusion criteria. Overall, SSRI use was associated with a significantly increased risk of fracture (relative risk, RR, 1.72; 95{\%} CI [1.51, 1.95]; P<0.001). An increased fracture risk associated with SSRIs also was observed in the three studies that adjusted for bone mineral density (RR, 1.70; 95{\%} CI [1.28, 2.25]; P<0.001) and in the four studies that adjusted for depression (RR 1.74; 95{\%} CI [1.28, 2.36]; P<0.001). SSRI use was not associated with bone loss in the two cohort studies of women (P=0.29). The overall association between SSRI use and fracture risk was weaker (RR, 1.40; 95{\%} CI [1.22, 1.61]), though still significant (P<0.001) in analyses that accounted for apparent publication bias. Conclusions Use of SSRIs is associated with increased risk of fracture. The SSRIs may exert an increased risk of fracture independent of depression and bone mineral density.",
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T1 - Selective serotonin reuptake inhibitor treatment and risk of fractures

T2 - Ameta-analysis of cohort and case-control studies

AU - Wu, Q.

AU - Bencaz, A. F.

AU - Hentz, J. G.

AU - Crowell, M. D.

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N2 - Summary Studies on use of selective serotonin reuptake inhibitors (SSRIs) and risk of fracture have yielded inconsistent results. This meta-analysis, which pooled results from 13 qualifying cohort and case-control studies, found that SSRIs were associated with a significantly increased risk of fractures. Introduction This study was conducted to assess whether people who take SSRIs are at an increased risk of fracture. Methods We conducted a meta-analysis of observational studies. Relevant studies published by February 2010 were identified through literature searches using MEDLINE (from 1966), EMBASE (from 1988), PsycINFO (from 1806), and manual searching of reference lists. Only cohort or case-control studies that examined the association of SSRIs and risk of fracture and bone loss were included. Data were abstracted independently by two investigators using a standardized protocol; disagreements were resolved by consensus. Random effects models were used for pooled analysis due to heterogeneity in the studies. Results Thirteen studies met inclusion criteria. Overall, SSRI use was associated with a significantly increased risk of fracture (relative risk, RR, 1.72; 95% CI [1.51, 1.95]; P<0.001). An increased fracture risk associated with SSRIs also was observed in the three studies that adjusted for bone mineral density (RR, 1.70; 95% CI [1.28, 2.25]; P<0.001) and in the four studies that adjusted for depression (RR 1.74; 95% CI [1.28, 2.36]; P<0.001). SSRI use was not associated with bone loss in the two cohort studies of women (P=0.29). The overall association between SSRI use and fracture risk was weaker (RR, 1.40; 95% CI [1.22, 1.61]), though still significant (P<0.001) in analyses that accounted for apparent publication bias. Conclusions Use of SSRIs is associated with increased risk of fracture. The SSRIs may exert an increased risk of fracture independent of depression and bone mineral density.

AB - Summary Studies on use of selective serotonin reuptake inhibitors (SSRIs) and risk of fracture have yielded inconsistent results. This meta-analysis, which pooled results from 13 qualifying cohort and case-control studies, found that SSRIs were associated with a significantly increased risk of fractures. Introduction This study was conducted to assess whether people who take SSRIs are at an increased risk of fracture. Methods We conducted a meta-analysis of observational studies. Relevant studies published by February 2010 were identified through literature searches using MEDLINE (from 1966), EMBASE (from 1988), PsycINFO (from 1806), and manual searching of reference lists. Only cohort or case-control studies that examined the association of SSRIs and risk of fracture and bone loss were included. Data were abstracted independently by two investigators using a standardized protocol; disagreements were resolved by consensus. Random effects models were used for pooled analysis due to heterogeneity in the studies. Results Thirteen studies met inclusion criteria. Overall, SSRI use was associated with a significantly increased risk of fracture (relative risk, RR, 1.72; 95% CI [1.51, 1.95]; P<0.001). An increased fracture risk associated with SSRIs also was observed in the three studies that adjusted for bone mineral density (RR, 1.70; 95% CI [1.28, 2.25]; P<0.001) and in the four studies that adjusted for depression (RR 1.74; 95% CI [1.28, 2.36]; P<0.001). SSRI use was not associated with bone loss in the two cohort studies of women (P=0.29). The overall association between SSRI use and fracture risk was weaker (RR, 1.40; 95% CI [1.22, 1.61]), though still significant (P<0.001) in analyses that accounted for apparent publication bias. Conclusions Use of SSRIs is associated with increased risk of fracture. The SSRIs may exert an increased risk of fracture independent of depression and bone mineral density.

KW - Antidepressant

KW - Bone fractures

KW - Bone mineral density

KW - Depression . Osteoporosis

KW - Serotonin reuptake inhibitors

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