Use of selective serotonin reuptake inhibitors and risk of fracture

A systematic review and meta-analysis

Chun Sick Eom, Hyun Ki Lee, Sungmin Ye, Sang Min Park, Kyung-Hwan Cho

Research output: Contribution to journalReview article

73 Citations (Scopus)

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 languageEnglish
Pages (from-to)1186-1195
Number of pages10
JournalJournal of Bone and Mineral Research
Volume27
Issue number5
DOIs
Publication statusPublished - 2012 May 1

Fingerprint

Serotonin Uptake Inhibitors
Meta-Analysis
Confidence Intervals
Odds Ratio
Osteoporotic Fractures
Hip Fractures
Risk Management
Wrist
Forearm
MEDLINE
Bone Density
Femur
Libraries
Observational Studies
Case-Control Studies
Spine
Cohort Studies
Databases
Population

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 journalReview article

Eom, Chun Sick ; Lee, Hyun Ki ; Ye, Sungmin ; Park, Sang Min ; Cho, Kyung-Hwan. / Use of selective serotonin reuptake inhibitors and risk of fracture : A systematic review and meta-analysis. In: Journal of Bone and Mineral Research. 2012 ; Vol. 27, No. 5. pp. 1186-1195.
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