title: Use of antidepressant medications and risk of fracture in older women.
abstract: 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.
authors: Division of Epidemiology & Community Health, Department of Medicine, University of Minnesota, Minneapolis, 55415, USA. sdiem@umn.edu
authors: Susan J
authors: SJ
authors: Diem
authors: Terri L
authors: TL
authors: Blackwell
authors: Katie L
authors: KL
authors: Stone
authors: Jane A
authors: JA
authors: Cauley
authors: Teresa A
authors: TA
authors: Hillier
authors: Elizabeth M
authors: EM
authors: Haney
authors: Kristine E
authors: KE
authors: Ensrud
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000187:drug effects / Q000502:physiology; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007407:Interviews as Topic; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors