Abstract
Previous studies have reported inconsistent findings regarding the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of fracture. We identified relevant studies by searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to October 20, 2010. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect. We identified 12 studies: seven case-control studies and five cohort studies. A meta-analysis of these 12 observational studies showed that the overall risk of fracture was higher among people using SSRIs (adjusted odds ratio [OR]=1.69, 95% confidence interval [CI] 1.51-1.90, I 2=89.9%). Subgroup analysis by adjusted number of key risk factors for osteoporotic fracture showed a greater increased fracture risk in those adjusted for fewer than four variables (adjusted OR=1.83, 95% CI 1.57-2.13, I 2=88.0%) than those adjusted for four or more variables (adjusted OR=1.38, 95% CI 1.27-1.49, I 2=46.1%). The pooled ORs anatomical site of fracture in the hip/femur, spine, and wrist/forearm were 2.06 (95% CI 1.84-2.30, I 2=62.3%), 1.34 (95% CI 1.13-1.59, I 2=48.5%), and 1.51 (95% CI 1.26-1.82, I 2=76.6%), respectively. Subgroup analysis by exposure duration revealed that the strength of the association decreased with a longer window of SSRI administration before the index date. The risk of fracture was greater within 6 weeks before the index date (adjusted OR=3.83, 95% CI 1.96-7.49, I 2=41.5%) than 6 weeks or more (adjusted OR=1.60, 95% CI 0.93-2.76, I 2=63.1%). Fracture risk associated with SSRI use may have a significant clinical impact. Clinicians should carefully consider bone mineral density screening before prescribing SSRIs and proper management for high-risk populations.
| Original language | English |
|---|---|
| Pages (from-to) | 1186-1195 |
| Number of pages | 10 |
| Journal | Journal of Bone and Mineral Research |
| Volume | 27 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 2012 May 1 |
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Keywords
- ANTIDEPRESSANTS
- FRACTURE
- META-ANALYSIS
- SELECTIVE SEROTONIN REUPTAKE INHIBITOR
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Endocrinology, Diabetes and Metabolism
Cite this
Use of selective serotonin reuptake inhibitors and risk of fracture : A systematic review and meta-analysis. / Eom, Chun Sick; Lee, Hyun Ki; Ye, Sungmin; Park, Sang Min; Cho, Kyung-Hwan.
In: Journal of Bone and Mineral Research, Vol. 27, No. 5, 01.05.2012, p. 1186-1195.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Use of selective serotonin reuptake inhibitors and risk of fracture
T2 - A systematic review and meta-analysis
AU - Eom, Chun Sick
AU - Lee, Hyun Ki
AU - Ye, Sungmin
AU - Park, Sang Min
AU - Cho, Kyung-Hwan
PY - 2012/5/1
Y1 - 2012/5/1
N2 - Previous studies have reported inconsistent findings regarding the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of fracture. We identified relevant studies by searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to October 20, 2010. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect. We identified 12 studies: seven case-control studies and five cohort studies. A meta-analysis of these 12 observational studies showed that the overall risk of fracture was higher among people using SSRIs (adjusted odds ratio [OR]=1.69, 95% confidence interval [CI] 1.51-1.90, I 2=89.9%). Subgroup analysis by adjusted number of key risk factors for osteoporotic fracture showed a greater increased fracture risk in those adjusted for fewer than four variables (adjusted OR=1.83, 95% CI 1.57-2.13, I 2=88.0%) than those adjusted for four or more variables (adjusted OR=1.38, 95% CI 1.27-1.49, I 2=46.1%). The pooled ORs anatomical site of fracture in the hip/femur, spine, and wrist/forearm were 2.06 (95% CI 1.84-2.30, I 2=62.3%), 1.34 (95% CI 1.13-1.59, I 2=48.5%), and 1.51 (95% CI 1.26-1.82, I 2=76.6%), respectively. Subgroup analysis by exposure duration revealed that the strength of the association decreased with a longer window of SSRI administration before the index date. The risk of fracture was greater within 6 weeks before the index date (adjusted OR=3.83, 95% CI 1.96-7.49, I 2=41.5%) than 6 weeks or more (adjusted OR=1.60, 95% CI 0.93-2.76, I 2=63.1%). Fracture risk associated with SSRI use may have a significant clinical impact. Clinicians should carefully consider bone mineral density screening before prescribing SSRIs and proper management for high-risk populations.
AB - Previous studies have reported inconsistent findings regarding the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of fracture. We identified relevant studies by searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to October 20, 2010. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect. We identified 12 studies: seven case-control studies and five cohort studies. A meta-analysis of these 12 observational studies showed that the overall risk of fracture was higher among people using SSRIs (adjusted odds ratio [OR]=1.69, 95% confidence interval [CI] 1.51-1.90, I 2=89.9%). Subgroup analysis by adjusted number of key risk factors for osteoporotic fracture showed a greater increased fracture risk in those adjusted for fewer than four variables (adjusted OR=1.83, 95% CI 1.57-2.13, I 2=88.0%) than those adjusted for four or more variables (adjusted OR=1.38, 95% CI 1.27-1.49, I 2=46.1%). The pooled ORs anatomical site of fracture in the hip/femur, spine, and wrist/forearm were 2.06 (95% CI 1.84-2.30, I 2=62.3%), 1.34 (95% CI 1.13-1.59, I 2=48.5%), and 1.51 (95% CI 1.26-1.82, I 2=76.6%), respectively. Subgroup analysis by exposure duration revealed that the strength of the association decreased with a longer window of SSRI administration before the index date. The risk of fracture was greater within 6 weeks before the index date (adjusted OR=3.83, 95% CI 1.96-7.49, I 2=41.5%) than 6 weeks or more (adjusted OR=1.60, 95% CI 0.93-2.76, I 2=63.1%). Fracture risk associated with SSRI use may have a significant clinical impact. Clinicians should carefully consider bone mineral density screening before prescribing SSRIs and proper management for high-risk populations.
KW - ANTIDEPRESSANTS
KW - FRACTURE
KW - META-ANALYSIS
KW - SELECTIVE SEROTONIN REUPTAKE INHIBITOR
UR - http://www.scopus.com/inward/record.url?scp=84859906973&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859906973&partnerID=8YFLogxK
U2 - 10.1002/jbmr.1554
DO - 10.1002/jbmr.1554
M3 - Review article
VL - 27
SP - 1186
EP - 1195
JO - Journal of Bone and Mineral Research
JF - Journal of Bone and Mineral Research
SN - 0884-0431
IS - 5
ER -