Relationship between use of antidepressants and risk of fractures: a meta-analysis

Summary It has been shown that antidepressants would
have a direct action on bone metabolism and would be
associated with increased fracture risk. Results from this
large meta-analysis show that both SSRIs and TCAs are
associated with a moderate and clinically significant
increase in the risk of fractures of all types.
Introduction This study seeks to investigate the relationship
between use of antidepressants and the risk of fracture.
Methods An exhaustive systematic research of case–control
and cohort studies published or performed between 1966
and April 2011 that reported risk estimates of fracture associated
with use of antidepressants was performed using
MEDLINE, PsycINFO, and the Cochrane Systematic
Review Database, manual review of the literature, and congressional
abstracts. Inclusion, quality scoring, and data
abstraction were performed systematically by three independent
reviewers.
Results A total of 34 studies (n01,217,464 individuals)
were identified. Compared with non-users, the random
effects pooled RR of fractures of all types, among antidepressant
users, were 1.39 (95%CI 1.32–1.47). Use of antidepressants
were associated with a 42 %, 47 %, and 38 %
risk increase in non-vertebral, hip, and spine fractures,
respectively ([For non-vertebral fractures: RR01.42, 95%CI
1.34–1.51]; [For hip fractures: RR01.47, 95%CI 1.36–1.58];
[For spine fractures: RR01.38, 95%CI 1.19–1.61]). Studies
examining SSRI use showed systematically a higher increase
in the risk of fractures of all types, non-vertebral, and hip
fractures than studies evaluating TCA use.
Conclusions Results from this large meta-analysis show
that both SSRIs and TCAs are associated with a moderate
and clinically significant increase in the risk of fractures of
all types.