Article

Fracture Risk From Psychotropic Medications

Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
Journal of clinical psychopharmacology (Impact Factor: 3.76). 09/2008; 28(4):384-91. DOI: 10.1097/JCP.0b013e31817d5943
Source: PubMed

ABSTRACT Selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and antipsychotics have each been associated with an increased risk of fracture in older individuals. The aim of this study was to better define the magnitude of fracture risk with psychotropic medications and to determine whether a dose-effect relationship exists.
Population-based administrative databases were used to examine psychotropic medication exposure and fractures in persons aged 50 years and older in Manitoba between 1996 and 2004. Persons with osteoporotic fractures (vertebral, wrist, or hip [n = 15,792]) were compared with controls (3 controls for each case matched for age, sex, ethnicity, and comorbidity [n = 47,289]). Medications examined included antidepressants (SSRIs vs other monoamines), antipsychotics, lithium, and benzodiazepines.
Selective serotonin reuptake inhibitors were associated with the highest adjusted odds of osteoporotic fractures (odds ratio [OR] = 1.45; 95% confidence interval [CI], 1.32-1.59). Other monoamine antidepressants (OR = 1.15; 95% CI, 1.07-1.24) and benzodiazepines (OR = 1.10; 95% CI, 1.04-1.16) were also associated with greater fracture risk, although the relationship was weaker. Lithium was associated with lower fracture risk (OR = 0.63; 95% CI, 0.43-0.93), whereas the relationship with antipsychotics was not significant in the models that adjusted for diagnoses. A dose-effect relationship was seen with SSRIs and benzodiazepines.
This study provides novel insight into the relationship between fractures and psychotropic medications in the elderly. Selective serotonin reuptake inhibitors seem to have a greater risk than other psychotropic classes, and higher doses may further increase that risk. Lithium seems to be protective against fractures.

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    • "In a sample with schizophrenia, current and prior use of antipsychotics increased the risk of hip fracture but no significant associations with dose or degree of blockade of the alpha-1 receptor or histamine-1 receptor were found (Hugenholtz et al., 2005). Bolton et al. found osteoporotic fracture to be associated with schizophrenia, but observed no independent effect of antipsychotics (Bolton et al., 2008). Pouwels et al. found a 1.76 fold increased risk of hip fracture in elderly people treated with conventional but not atypical antipsychotics (Pouwels et al., 2009). "
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    • "3 Abrahamsen et al., 2009 (15) Denmark Case-control Men !50 years Any/hip/spine fracture Cases: NR/15,716 1995– 2000 Age, fracture history, modified Charlson comorbidity index Controls: NR/47,149 4 Bolton et al., 2008 "
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    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 05/2012; 27(5):1186-95. DOI:10.1002/jbmr.1554 · 6.59 Impact Factor
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    • "These effects are greater in magnitude and more consistent than observed in users of TCAs [6] [8] [9] [12]. In terms of lithium, there is preliminary evidence that it improves femoral neck and spine BMD [43], and decreases fracture risk [6] [10]. "
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