SSRI use and risk of fractures among perimenopausal women without mental disorders
- 1Department of Epidemiology, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- 2Department of Social and Behavioral Sciences, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- 3Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- 4Department of Health Policy and Management, Harvard University, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- 5Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
- Correspondence to Dr Matthew Miller, Department of Health Science, Northeastern University, Room 316 RB, 360 Huntington Avenue, Boston, MA 02115-5000, USA;
- Received 10 November 2014
- Revised 21 March 2015
- Accepted 17 April 2015
- Published Online First 25 June 2015
Background Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally.
Methods Female patients without mental illness, aged 40–64 years, who initiated SSRIs were compared with a cohort who initiated H2 antagonists (H2As) or proton-pump inhibitors (PPIs) in 1998–2010, using data from a claims database. Standardised mortality ratio weighting was applied using the propensity score odds of treatment to adapt the distribution of characteristics among patients starting H2A/PPIs to the distribution among SSRI initiators. Poisson regression estimated risk differences and Cox proportional hazards regression the RR of fractures among new users of SSRIs versus H2A/PPIs. Primary analyses allowed for a 6-month lag period (ie, exposure begins 6 months after initiation) to account for a hypothesised delay in the onset of any clinically meaningful effect of SSRIs on bone mineral density.
Results Fracture rates were higher among the 137 031 SSRI initiators compared with the 236 294 H2A/PPI initiators, with HRs (SSRI vs H2A/PPI) over 1, 2 and 5 years of 1.76 (95% CI 1.33 to 2.32), 1.73 (95% CI 1.33 to 2.24) and 1.67 (95% CI 1.30 to 2.14), respectively.
Conclusions SSRIs appear to increase fracture risk among middle-aged women without psychiatric disorders, an effect sustained over time, suggesting that shorter duration of treatment may decrease fracture risk. Future efforts should examine whether this association pertains at lower doses.