Selective serotonin reuptake inhibitors and osteoporosis: a target trial emulation using real-world data.

IF 2.6 4区 医学 Q3 NEUROSCIENCES
Christopher Rohde, Lana J Williams, Michael Berk, Søren Dinesen Østergaard
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引用次数: 0

Abstract

Objectives: Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of osteoporosis, and sertraline may be more potent than citalopram in this regard. Here, target trial emulation was used to investigate whether sertraline, citalopram and escitalopram (the S-enantiomer of citalopram) differentially affect the risk of osteoporosis. Subsequently, it was examined whether SSRIs increase the risk of osteoporosis in a dose-response-like manner.

Methods: Danish nationwide registers were used to identify all individuals that initiated treatment for depression with sertraline, citalopram, or escitalopram between January 1, 2007, and March 1, 2019. These individuals were followed until development of osteoporosis, death, or end of follow-up. Cox proportional hazards regression was used to adjust for relevant baseline covariates to emulate randomised treatment allocation to compare the rate of osteoporosis for individuals treated with sertraline, citalopram or escitalopram. Subsequently, the cumulative dose of sertraline, citalopram, and escitalopram was calculated, and Cox proportional hazards regression was used to assess dose-response-like relationships with osteoporosis.

Results: We identified 27,280, 65,529, and 17,703 individuals initiating treatment with sertraline, citalopram, and escitalopram, respectively. There was no material or statistically significant differential risk of osteoporosis between these groups (adjusted hazard rate ratio, aHRR = 0.98 for citalopram versus sertraline and aHRR = 0.94 for escitalopram versus sertraline). The results were not indicative of the SSRIs having a dose-response-like effect on osteoporosis risk.

Conclusions: Sertraline, citalopram and escitalopram do not appear to differentially affect the risk of osteoporosis. The lack of clear dose-response-like relationships suggest that they do not have a causal effect on osteoporosis risk.

选择性血清素再摄取抑制剂(SSRIs)和骨质疏松症:使用真实世界数据的目标试验模拟。
目的:选择性血清素再摄取抑制剂(SSRIs)与骨质疏松症风险增加有关,在这方面舍曲林可能比西酞普兰更有效。本研究采用目标试验模拟来研究舍曲林、西酞普兰和艾司西酞普兰(西酞普兰的s -对映体)是否以剂量-反应样方式影响骨质疏松的风险,以及是否以剂量-反应样方式增加骨质疏松的风险。方法:使用丹麦全国登记册来识别2007年1月1日至2019年3月1日期间开始使用舍曲林、西酞普兰或艾司西酞普兰治疗抑郁症的所有个体。这些人被跟踪,直到骨质疏松症的发展,死亡,或随访结束。采用Cox比例风险回归调整相关基线协变量,模拟随机治疗分配,比较使用舍曲林、西酞普兰或艾司西酞普兰治疗的个体的骨质疏松率。随后,计算舍曲林、西酞普兰和艾司西酞普兰的累积剂量,并使用Cox比例风险回归评估剂量-反应样与骨质疏松症的关系。结果:我们分别确定了27,280,65,529和17,703人开始使用舍曲林,西酞普兰和艾司西酞普兰进行治疗。两组间骨质疏松风险无显著差异(西酞普兰vs舍曲林的HRR=0.98,艾司西酞普兰vs舍曲林的HRR=0.94)。结果并不表明ssri类药物对骨质疏松风险具有剂量-反应效应。结论:舍曲林、西酞普兰和艾司西酞普兰对骨质疏松风险的影响似乎没有差异。缺乏明确的剂量-反应类关系表明它们对骨质疏松症风险没有因果影响。
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来源期刊
Acta Neuropsychiatrica
Acta Neuropsychiatrica NEUROSCIENCES-PSYCHIATRY
自引率
5.30%
发文量
30
期刊介绍: Acta Neuropsychiatrica is an international journal focussing on translational neuropsychiatry. It publishes high-quality original research papers and reviews. The Journal''s scope specifically highlights the pathway from discovery to clinical applications, healthcare and global health that can be viewed broadly as the spectrum of work that marks the pathway from discovery to global health.
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