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Certain antidepressants linked to increased hip fracture risk for patients on hemodialysis
Researchers of a published study found both short- and long-term use of selective serotonin reuptake inhibitors was associated with increased risk for hip fracture among patients on hemodialysis.
“Antidepressants are frequently prescribed to manage anxiety and depression associated with advanced organ failure,” Chandan Vangala, MD, MS, of the section of nephrology at Baylor College of Medicine in Houston, and colleagues wrote. “Within the general population, antidepressants have been linked to increased fracture risk and, more specifically, selective serotonin reuptake inhibitors (SSRIs) have been associated with hip fractures. Effects on both bone metabolism and falls have been touted as potential mechanisms of increased risk. However, the bone pathology associated with kidney disease is both diverse and distinct from osteoporosis. Thus, the impact of SSRIs on hip fracture risk in maintenance dialysis patients remains unexplored.”
Using the U.S. Renal Data System, researchers identified 4,912 patients on hemodialysis who experienced hip fracture and matched each of them to 10 controls with the same risk set. Through Medicare Part D claims, SSRI use was categorized based on how many days were covered by filled prescriptions within a 3-year period (any: at least one filled prescription; low: <20% of days covered by filled prescription; moderate: 20% to 80% of days; high: 80% of days).
Researchers found SSRI use was associated with increased hip fracture risk, with adjusted conditional odds ratio estimates of 1.25 for any use; 1.20 for low use; 1.31 for moderate use and 1.26 for high use. Results of a separate analysis conducted to specifically examine new short-time SSRI use (defined as starting use in the 6 months before fracture) also linked SSRI use to increased hip fracture risk with conditional ORs of 1.82 for any use vs. 1.43 for no use.
“With the benefits of antidepressant therapy undetermined and the risk for undesired effects present, any association between antidepressant drug therapy and risk for hip fracture is of potential clinical importance,” the researchers concluded. “In light of similar associations repeatedly demonstrated in the general population, this finding draws attention to potentially unwanted consequences of what has largely been a unimodal approach to depression in patients with kidney failure treated by kidney replacement therapy.” – by Melissa J. Webb
Disclosures: Vangala reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.