Friday, January 13, 2017

Antidepressants May Increase Risk of Hip Fractures in Older Adults

Older adults taking antidepressants—particularly those with Alzheimer’s disease (AD)—appear to be at a greater risk of hip fracture than older adults not taking the medications, according to a report in the International Journal of Geriatric Psychiatry.

“Antidepressant use is associated with an increased risk of incident hip fracture among older persons with and without AD,” the study authors wrote. “Thus, if the antidepressant treatment is necessary, other risk factors for falling should be carefully considered.”

For the study, researchers from the University of Eastern Finland compared the health outcomes of 50,491 community-dwelling adults who were diagnosed with AD (mean age 80) and 100,982 age- and sex-matched controls without an AD diagnosis documented in national registers over a four-year period.

A total of 22.4% of the people with AD and 9.9% of persons without AD started taking antidepressants during the study period. (The most frequently initiated antidepressants included selective serotonin reuptake inhibitors, mirtazapine, and selective noradrenaline reuptake inhibitors.) 

During antidepressant use, the age-adjusted rate of hip fractures per 100 person-years was 3.01 among persons with AD and 2.28 among persons without AD. Antidepressant use was associated with an increased risk of hip fracture among persons with and without AD (adjusted hazard ratio [HR]=1.61; HR=2.71, respectively) compared with nonuse. This increased risk remained even after adjusting for use of antipsychotics, benzodiazepines, and other psychotropic drugs during the follow-up period.

“In our study, the adjusted hazard ratio was higher among persons without AD than in persons with AD. However, we found age-adjusted event rate for hip fracture per 100 person-years during antidepressant use was higher among persons with AD compared with persons without AD, which indicates the vulnerability of persons with AD.”

Additional analysis revealed that the risk of hip fracture was highest at the beginning of antidepressant use (1 to 30 days) in people with AD and without AD (HR=3.30; HR=3.92, respectively), but remained throughout the follow-up.

For related information, see the Psychiatric Services article “Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression.” 

(Image: iStock/Barcin)