Risk of fractures with selective serotonin-reuptake inhibitors or tricyclic antidepressants.
OBJECTIVE
To evaluate the literature associating the risk of fracture during antidepressant therapy.


METHODS
Literature was identified via MEDLINE (1970-August 2008) using the search terms selective serotonin-reuptake inhibitors, tricyclic antidepressants, antidepressants, and fracture. Reference citations from publications identified were also reviewed. All articles in English identified from the data sources were evaluated.


RESULTS
Selective serotonin-reuptake inhibitors (SSRIs) are generally prescribed over other classes of antidepressants because they are considered to be relatively safer. Recent evidence, however, suggests that SSRIs may be associated with an increased risk of fractures. Thirteen clinical studies were identified in the literature search (7 case controls, 5 prospective cohorts, 1 cross-sectional). Most studies compared SSRIs with tricyclic antidepressants (TCAs) and found similar or greater risk of fracture associated with use of an SSRI. This risk appeared to be highest at the beginning of therapy with TCAs and eventually diminished. SSRI risk tended to increase slightly over time. No risk was seen with other classes of antidepressants. However, the number of patients using antidepressants was low.


CONCLUSIONS
There may be a possible correlation with SSRI or TCA use and risk of fracture. Prospective, randomized controlled trials with sufficient patient samples are needed to verify this finding.
Ginzburg
Regina
R
College of Pharmacy and Allied Health Professions, St. John's University, Jamaica, NY 11439, USA. ginzburr@stjohns.edu
Rosero
Enma
E
D000818:Animals; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D050723:Fractures, Bone / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors