ReviewCurrent osteoporosis reports2016
Do Selective Serotonin Reuptake Inhibitors (SSRIs) Cause Fractures?
Review in Current osteoporosis reports, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Antidepressant use and the risk of seizure: a meta-analysis of observational studies.European journal of clinical pharmacology · 2024Pooled it
- The effect of SSRIs on Semen quality: A systematic review and meta-analysis.Frontiers in pharmacology · 2022Pooled it
- Article
- Antidepressant Use and Bone Health: Evidence From Mendelian Randomisation.Actas espanolas de psiquiatria · 2026Article
- The Effect of Tricyclic Antidepressants on Fracture Healing: An Experimental Study.Current pharmaceutical design · 2026Article
- Paroxetine Triggers Inflammatory State on Zebrafish Early Embryonic Development.Life (Basel, Switzerland) · 2025Article
- Risk of osteoporotic fractures in menopausal women with common mental health diagnoses prescribed SSRIs/SNRIs: cohort and self-controlled case series analyses.Archives of osteoporosis · 2024Article
- Association between the type of hypnotic drug and in-hospital fractures in older patients with neurocognitive disorders: A case-control study using a nationwide database.Geriatrics & gerontology international · 2023Article
- Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I.Arquivos de neuro-psiquiatria · 2022Article
- Article
- Selective serotonin reuptake inhibitors (SSRI) affect murine bone lineage cells.Life sciences · 2020Article
- Increased risk for hip fracture after death of a spouse-further support for bereavement frailty?Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2020Article
- Association Between Antidepressant Drug Use and Hip Fracture in Older People Before and After Treatment Initiation.JAMA psychiatry · 2019Article
- Gut-derived serotonin contributes to bone deficits in colitis.Pharmacological research · 2019Article
- Neuronal hypothalamic regulation of body metabolism and bone density is galanin dependent.The Journal of clinical investigation · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Recent meta-analyses report a 70 % increase in fracture risk in selective serotonin reuptake inhibitor (SSRI) users compared to non-users; however, included studies were observational and limited in their ability to establish causality. Here, we use the Bradford Hill criteria to explore causality between SSRIs and fractures. We found a strong, consistent, and temporal relationship between SSRIs and fractures, which appears to follow a biological gradient. However, specificity and biological plausibility remain concerns. In terms of specificity, the majority of available data have limitations due to either confounding by indication or channeling bias. Self-controlled case series address some of these limitations and provide relatively strong observational evidence for a causal relationship between SSRIs and fracture. In doing so, they suggest that falls contribute to fractures in SSRI users. Whether there are also underlying changes in skeletal properties remains unresolved. Initial studies provide some evidence for skeletal effects of SSRIs; however, the pathways involved need to be established before biological plausibility can be accepted. As the link between SSRIs and fractures is based on observational data and not evidence from prospective trials, there is insufficient evidence to definitively determine a causal relationship and it appears premature to label SSRIs as a secondary cause of osteoporosis. SSRIs appear to contribute to fracture-inducing falls, and addressing any fall risk associated with SSRIs may be an efficient approach to reducing SSRI-related fractures. As fractures stemming from SSRI-induced falls are more likely in individuals with compromised bone health, it is worth considering bone density testing and intervention for those presenting with risk factors for osteoporosis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.