New MUHC study shows increased risk of bone fracture in elderly people on daily medication for depression
A new study led by researchers at the McGill University Health Centre (MUHC) has revealed that elderly people taking selective serotonin reuptake inhibitors (SSRIs) on a daily basis for depression may double their risk of suffering osteoporotic bone fractures. The research, published today in the journal Archives of Internal Medicine, was conducted in collaboration with researchers from McMaster University, Duke University and the University of British Columbia.
"Depression is a common ailment among the elderly, affecting approximately 10% of primary care patients in the United States," says Dr. Brent Richards, a former post-doctoral fellow at the MUHC and lead author of the new study. "Selective serotonin reuptake inhibitors (SSRIs) are the first-line therapy for the treatment of depression, particularly among the elderly, because of the presumption of fewer side effects."
Some studies, however, have associated SSRIs with increased risk of fragility fractures in the elderly. "The results from these previous studies were unclear because they used data from administrative databases and did not reliably control for variables, such as falls, lifestyle behavior, symptoms of depression and bone mineral density, which may confound the relationship between SSRI use and fractures," says Dr. David Goltzman, Director of the Metabolic Bone Disease Centre at the MUHC, Director of the McGill Centre for Bone and Periodontal Research, professor in the Faculty of Medicine at McGill University, and senior author of the study.
The investigators of the new research evaluated over 5,000 randomly selected people in the Canadian MultiCentre Osteoporosis Study (CaMOS), 137 of whom took SSRIs on a daily basis. "Our study, which controlled for factors that may affect the reliability of the data, shows that daily SSRI use is associated with a twofold increase in bone fractures caused by low trauma, such as falling from a standing height," says Dr. Richards, who is currently based at King's College in London. The study also revealed that people who take SSRIs daily also increase their risk of falls and have a lower bone mineral density at the hip, and a trend toward lower bone mineral density at the spine. The effects were found to be SSRI dose dependent.
Both depression and fragility fractures are common in this age group, and the elevated risk attributed to daily SSRI use may have important public health consequences. "Daily SSRI use in the elderly to treat depression may increase the risk of subsequent fracture, but this risk must be balanced against the potentially larger benefits gained by treatment of their depression," says Dr. Richards.
Funding for CaMOS was provided by the Canadian Institutes of Health Research (CIHR), Merck Frosst Canada Ltd, Eli Lilly Canada Inc, Novartis Pharmaceuticals Inc, the Alliance for Better Bone Health (Sanofi-Aventis and Procter & Gamble Pharmaceuticals Canada Inc), the Dairy Farmers of Canada, and the Arthritis Society.
The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, a university health centre affiliated with the Faculty of Medicine at McGill University. The institute supports over 500 researchers, nearly 1,000 graduate and post-doctoral students, and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge. For further details visit: www.muhc.ca/research.
The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University — the Montreal Children's, Montreal General, Royal Victoria, and Montreal Neurological Hospitals, as well as the Montreal Chest Institute. Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge. www.muhc.ca
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