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Depression, psychotropic medication increase fracture risk

Depression and use of serotonin reuptake inhibitors, mood stabilizers, antipsychotics and benzodiazepines significantly increased risk for major osteoporotic fracture and hip fracture in adults aged 40 years and older.

“Mental disorders such as depression have been associated with an increased risk of osteoporosis and fracture. Likewise, specific psychotropic medications have been consistently associated with lower bone mineral density and increased risk of fracture, independent of the mental disorders they are treating,” James M. Bolton, MD, of University of Manitoba, Winnipeg, Canada, and colleagues wrote.

To assess associations between mental disorders, psychotropic medications and risk for osteoporotic fracture, researchers conducted a population-based cohort study of 68,370 individuals. Data from the Manitoba Bone Density Program for all adults aged 40 years and older in Manitoba were used to determine FRAX scores and population-based health services data identified primary mental disorders, psychotropic medication use and incident fractures.

Overall, 8.4% of participants sustained an incident major osteoporotic fracture, 2.3% sustained an incident hip fracture, and 13.1% died.

Analyses adjusted for FRAX score indicated depression was associated with major osteoporotic fracture (adjusted HR = 1.39; 95% CI, 1.27-1.51; P < .05) and hip fracture (aHR = 1.43; 95% CI, 1.22-1.69; P < .05).

These associations were not significant after adjusting for medication use.

Use of selective serotonin reuptake inhibitors (SSRIs) (aHR for major osteoporotic fracture = 1.43; 95% CI, 1.27-1.6; aHR for hip fracture = 1.48; 95% CI, 1.18-1.85), antipsychotics (aHR for major osteoporotic fracture = 1.43; 95% CI, 1.15-1.77; aHR for hip fracture = 2.14; 95% CI, 1.52-3.02), and benzodiazepines (aHR for major osteoporotic fracture = 1.15; 95% CI, 1.04-1.26; aHR for hip fracture = 1.24; 95% CI, 1.05-1.47) were associated with increased risk for major osteoporotic fracture and hip fracture.

FRAX significantly underestimated 10-year risk for major osteoporotic fracture by 29% and hip fracture by 51% for participants with depression, according to researchers.

FRAX underestimated the 10-year risk for major osteoporotic fracture by 36% for use of SSRIs, 63% for mood stabilizers, 60% for antipsychotics, and 13% for benzodiazepines.

Ten-year risk for hip fracture was underestimated by FRAX by 57% for use of SSRIs, 98% for mood stabilizers, 171% for antipsychotics, and 31% for benzodiazepines.

FRAX accurately estimated risk for individuals without mental disorders and not taking psychotropic medications.

“Osteoporosis and mental disorders are highly prevalent conditions, and, as such, these findings have substantial implications for mental health care workers and primary care practitioners. Broader public health initiatives and advocacy may be required to achieve better recognition and management of this elevated risk of fracture given that patients with psychiatric illness may not receive optimal treatment for comorbid physical health conditions,” the researchers concluded. – by Amanda Oldt

Disclosure: Bolton reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.