Study casts doubt on link between antidepressants, hip fracture

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Takeaway

  • There is a well-established association between antidepressants and excess risk of hip fractures in older people.
  • This study questions that association by finding as strong an association in the year before and after initiating antidepressants.

Why this matters

  • Antidepressants may not increase hip fracture risk, although an editorialist still advises warning elderly users.

Study design

  • Nationwide cohort (n=408,144) of older (≥65 years) antidepressant users and nonusers matched by sex and birth year from the Prescribed Drugs Register of Sweden (2006-2011).
  • Hip fracture outcomes from the Swedish National Patient Register were compared from 1 year before through 1 year after the index date when the prescription was filled (treatment initiation).
  • Funding: Swedish Research Council.

Key results

  • Users (vs nonusers) had >2 times higher incidents of hip fracture in the year before (5642 vs 2189) as well as after (7137 vs 2625) initiating treatment.
  • The association between hip fracture and antidepressant use was highest 16-30 days before initiating treatment (OR, 5.76; 95% CI, 4.73-7.01) and second highest was 31-91 days before initiating treatment (OR, 4.14; 95% CI, 3.71-4.61).
  • The pattern held for both genders, individual antidepressants, and high vs low doses, indicating no dose-response relationship.

Limitations

  • No information about the underlying indication for prescribing antidepressants (e.g., depression, sleep disorders, dementia).