Selective serotonin reuptake inhibitors (SSRIs), taken to curb menopausal symptoms, may boost bone fracture risk, according to a study published online ahead of print June 25 in the journal Injury Prevention. The heightened risk may persist for several years, according to the study findings, prompting the researchers to suggest that shorter treatment length may be preferable.
Lead author Yi-han Sheu, a doctoral student at Harvard University, and research colleagues at Harvard and the University of North Carolina at Chapel Hill used the PharMetrics Claims Database, which contains detailed information about medical and drug treatment claims made by 61 million patients in more than 98 managed care plans in the US.
The researchers focused on 137,031 women with no mental health issues who were between the ages of 40 and 64 and who started treatment with SSRIs between 1998 and 2010. The SSRIs included citalopram, hyrdrobromide, escitalopram oxalate, fluoxetine hyrdrochloride, fluvoxamine maleate, paroxetine hydrochloride, and sertraline hydrochloride.
Participants were compared with more than 236,294 women of the same age who were prescribed H2 antagonists or proton pump inhibitors, typically used to treat indigestion, over the same timeframe. An analysis of the data showed that fracture rates were significantly higher among the women treated with SSRIs.
The fracture rate was 76% higher among those prescribed SSRIs 1 year after starting treatment, 73% higher after 2 years, and 67% higher after 5 years than it was among those treated with indigestion drugs.
While the observational study offered no definitive conclusions on causality, the researchers suggested that antidepressants may alter bone turnover, shifting the balance in favor of bone thinning rather than bone strengthening activities.
“SSRIs appear to increase fracture risk among middle aged women without psychiatric disorders, an effect sustained over time, suggesting that shorter duration of treatment may decrease [this],” stated the researchers.
The study authors pointed out that the number of women prescribed SSRIs for menopausal symptoms is likely to increase in the wake of the FDA’s approval of another SSRI for this treatment indication.