Are selective serotonin reuptake inhibitors associated with fractures?

The cohort comprised 10,621 women aged 40 years and older who started SSRIs within the data collection time frame; they were followed up for a mean duration of 3 years. Adherence was classified as low (proportion of days covered [PDC] ≤20%), intermediate (PDC 21%-79%) or high (PDC ≥80%) and was assessed based on automated health plan data that accounted for prescription dispensing in the community and hospital discharge data. The study outcome of bone loss-related events was defined as a fracture or initiation of bisphosphonate therapy. To minimize surveillance bias and events related to postural adverse effects, events occurring within the first 180 days of follow-up were excluded. Results were also adjusted for age, primary care visits and body mass index. In patients with intermediate and high adherence, the aHR for bone loss-related events was 1.15 (95% CI: 0.97-1.37) and 1.40 (95% CI: 1.14-1.73), respectively, when compared with those with poor adherence, showing that higher SSRI adherence was associated with an increase in bone loss-related events. Compared with the meta-analyses above, the lower aHR may be attributable to a younger study population. In addition, using initiation of bisphosphonate therapy as an outcome could be problematic, as bisphosphonate therapy may be initiated in women with osteopenia as opposed to a fragility fracture. This study assessed the fracture risk related to SSRI or serotonin-norepinephrine reuptake inhibitor (SNRI; e.g., venlafaxine) use. The study used information gathered from an interviewer-administered questionnaire that focused on the patient's medical history, fracture risk factors and medication use and was administered at 0, 5 and 10 years. The main outcome was clinical fragility fractures (i.e., fractures caused by minimal trauma and confirmed by medical or radiographic reports). Of 6645 subjects, 192 were using an SSRI or SNRI at the study's outset and 333 were using an SSRI or SNRI at year 10. After adjustments for age, sex, education level, Charlson score (the Charlson Comorbidity Index is a scoring tool designed to predict mortality by weighting comorbidities), smoking, falls in the previous month, BMD (hip and lumbar), thiazolidinedione use, vitamin D level and previous deformity, the aHR was 1.68 (95% CI: 1.32-2.14). This aHR assumes that SSRI/SNRI use was constant between interviews. The results of a further analysis that used a more conservative definition (assuming SSRI/SNRI use for only 1 year if n