The Risk of Fracture Among Women Starting Selective Serotonin Reuptake Inhibitors.

IF 5.9 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Daniel H Solomon, Kristine M Ruppert, Pam Lian, Genevieve Neal-Perry, Jane A Cauley, Sherri-Ann M Burnett-Bowie
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引用次数: 0

Abstract

Increased fracture risk has been reported in patients using selective serotonin reuptake inhibitors (SSRIs). However, prior studies have had limited information regarding bone mineral density (BMD) and symptoms of depression, both potentially important confounders. We examined a longitudinal cohort of women who initiated SSRIs, other anti-depressant (AD) medications, or no AD to estimate the risk of fracture associated with start of SSRIs. The Study of Women's Health Across the Nation (SWAN) is a longitudinal cohort of diverse women from across the US transitioning across the menopause. Study visits are approximately yearly, with reporting of medication use, fracture incidence (any and non-traumatic), mental health scales (CES-D), and BMD (the latter occurring in selected SWAN sites). We estimated fracture incidence and relative risk among women starting SSRIs or other AD, and compared them with women not starting SSRIs or other AD. Multivariable Cox regression models with increasing adjustment were constructed. As well, secondary analyses focused on non-traumatic fractures and women with BMD measurements. SWAN includes 3,302 total women, of which 286 were excluded because of prevalent antidepressant use and 1,167 because they did not have adequate follow-up time, had a fracture prior to start of an AD, or could not be matched; this left 1,849 women for analysis. The incidence rates for any fracture (per 100 person-years) for SSRI users was 2.64 (95% CI 1.82 - 3.71), other AD users 0.80 (95% CI 0.22 - 2.04), and non-users 1.21 (95% CI 1.07 - 1.36). Fully adjusted regression models found an increased hazard ratio for any fracture among women starting SSRIs compared with no AD (HR 1.77, 95% CI 1.15 - 2.74). These results were consistent for non-traumatic fractures and in subgroups with BMD included as a covariate. Initiation of SSRI among women in mid-life was associated with an increased risk of fracture.

选择性5 -羟色胺再摄取抑制剂治疗女性骨折的风险
有报道称,使用选择性血清素再摄取抑制剂(SSRIs)的患者骨折风险增加。然而,先前的研究对骨密度(BMD)和抑郁症状的信息有限,两者都是潜在的重要混杂因素。我们研究了一项纵向队列研究,研究对象包括服用SSRIs类药物、其他抗抑郁药物(AD)或未服用AD的女性,以估计服用SSRIs类药物后骨折的风险。全国妇女健康研究(SWAN)是一个纵向队列,来自美国各地的不同女性在更年期过渡。研究访问大约每年一次,报告药物使用情况、骨折发生率(任何和非创伤性)、心理健康量表(CES-D)和骨密度(后者发生在选定的SWAN部位)。我们估计了服用SSRIs类药物或其他AD的女性的骨折发生率和相对风险,并将其与未服用SSRIs类药物或其他AD的女性进行了比较。构建了多变量Cox回归模型。此外,次要分析集中在非创伤性骨折和骨密度测量的女性。SWAN共纳入3302名女性,其中286名因普遍使用抗抑郁药而被排除,1167名因没有足够的随访时间、在AD开始前发生骨折或无法匹配而被排除;这就留下了1849名女性供分析。SSRI使用者的任何骨折发生率(每100人年)为2.64 (95% CI 1.82 - 3.71),其他AD使用者为0.80 (95% CI 0.22 - 2.04),非使用者为1.21 (95% CI 1.07 - 1.36)。完全调整后的回归模型发现,与未服用AD的女性相比,服用SSRIs的女性发生骨折的风险比增加(HR 1.77, 95% CI 1.15 - 2.74)。这些结果在非创伤性骨折和包括骨密度作为协变量的亚组中是一致的。中年妇女开始服用SSRI与骨折风险增加有关。
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来源期刊
Journal of Bone and Mineral Research
Journal of Bone and Mineral Research 医学-内分泌学与代谢
CiteScore
11.30
自引率
6.50%
发文量
257
审稿时长
2 months
期刊介绍: The Journal of Bone and Mineral Research (JBMR) publishes highly impactful original manuscripts, reviews, and special articles on basic, translational and clinical investigations relevant to the musculoskeletal system and mineral metabolism. Specifically, the journal is interested in original research on the biology and physiology of skeletal tissues, interdisciplinary research spanning the musculoskeletal and other systems, including but not limited to immunology, hematology, energy metabolism, cancer biology, and neurology, and systems biology topics using large scale “-omics” approaches. The journal welcomes clinical research on the pathophysiology, treatment and prevention of osteoporosis and fractures, as well as sarcopenia, disorders of bone and mineral metabolism, and rare or genetically determined bone diseases.
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