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Elevated fracture risk among perimenopausal women taking SSRIs

Post-menopausal, mentally-well women who take selective serotonin reuptake inhibitors for the treatment of menopausal symptoms are at an increased risk for fractures for years following medication initiation, according to recently published data.

“Our analyses found that among a population of middle-ages women without psychiatric diagnoses, compared with patients initiating [H2 antagonists] or [proton-pump inhibitors], patients who initiated treatment with [selective serotonin reuptake inhibitors] had significantly higher fracture risk over the entire 5-year study period. This finding is consistent with results from studies involving patients with mental health disorders,” the researchers wrote.

To assess the correlation between fracture risk and selective serotonin reuptake inhibitor (SSRI) use, the researchers compared one cohort of women who initiated use of SSRIs (n = 137,031) with a cohort of women who initiated use of H2 antagonists (H2As) or proton-pump inhibitors (PPIs) (n = 236,294). Participants were aged 40-64 years, and had not been diagnosed with any mental illnesses.

Results demonstrated that 6 months after initiation, the SSRI group had significantly higher fracture risks compared with the H2A and PPI group.

At 1 year after initiation, the SSRI group were at increased risk for fractures, compared with the H2A and PPI group (HR = 1.76; 95% CI, 1.33-2.32). Similar trends were also seen at 2 and 5 years after initiation (HR = 1.73; 95% CI, 1.33-2.24, HR = 1.67; 95% CI, 1.3-2.14, respectively).

“Our findings suggest that, if feasible, shorter duration of treatment might mitigate the risk of developing excess fractures. Since the number of SSRI users without psychiatric disorders is expected to increase following the FDA approval of paroxetine for the treatment of [vasomotor symptoms], particularly at lower doses, future efforts should be made to examine how SSRI dose (cumulative, daily or both) might modify fracture risk over time,” the researchers concluded. – by Casey Hower

Disclosure: Sheu reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.