ArticleJournal of the American Geriatrics Society2020
Multinational Investigation of Fracture Risk with Antidepressant Use by Class, Drug, and Indication.
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Medication and bone health in multiple sclerosis: A systematic review and meta-analysis.Journal of managed care & specialty pharmacy · 2023Pooled it
- Rates of fractures by medication type in patients with bipolar disorder: A retrospective cohort analysis.Journal of orthopaedics · 2025Article
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- Selective serotonin reuptake inhibitors and osteoporosis: a target trial emulation using real-world data.Acta neuropsychiatrica · 2025Article
- Influence of Ageing on the Pharmacodynamics and Pharmacokinetics of Chronically Administered Medicines in Geriatric Patients: A Review.Clinical pharmacokinetics · 2025Review
- Factors affecting extremity fracture risk in children with attention-deficit/hyperactivity disorder.Turkish journal of medical sciences · 2025Article
- Project MOVE: A randomized controlled trial of Interventions for initiating and maintaining physical activity in depressed individuals.Mental health and physical activity · 2023Article
- Risk Factors and Consequences of Lower Extremity Fracture Nonunions in Veterans With Spinal Cord Injury.JBMR plus · 2022Article
- Risk of Fall-Related Injuries Associated with Antidepressant Use in Elderly Patients: A Nationwide Matched Cohort Study.International journal of environmental research and public health · 2022Article
- Population-Based Signals of Antidepressant Drug Interactions Associated With Unintentional Traumatic Injury.Clinical pharmacology and therapeutics · 2021Article
- Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units.BMC geriatrics · 2020Article
- Tricyclic Antidepressant Use and Risk of Fractures: A Meta-Analysis of Cohort Studies through the Use of Both Frequentist and Bayesian Approaches.Journal of clinical medicine · 2020Review
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Authors and funding
10 authors at 6 institutions in 4 countries.
Funding
Abstract
objectivesAntidepressants increase the risk of falls and fracture in older adults. However, risk estimates vary considerably even in comparable populations, limiting the usefulness of current evidence for clinical decision making. Our aim was to apply a common protocol to cohorts of older antidepressant users in multiple jurisdictions to estimate fracture risk associated with different antidepressant classes, drugs, doses, and potential treatment indications.
designRetrospective (2009-2014) cohort study.
settingFive jurisdictions in the United States, Canada, United Kingdom, and Taiwan.
participantsOlder antidepressant users-subjects were followed from first antidepressant prescription or dispensation to first fracture or until the end of follow-up. MEASUREMENTS: The risk of fractures with antidepressants was estimated by multivariable Cox proportional hazards models using time-varying measures of antidepressant dose and use vs nonuse, adjusting for patient characteristics.
resultsBetween 42.9% and 55.6% of study cohorts were 75 years and older, and 29.3% to 45.4% were men. Selective serotonin reuptake inhibitors (SSRIs) (48.4%-60.0%) were the predominant class used in North America compared with tricyclic antidepressants (TCAs) in the United Kingdom and Taiwan (49.6%-53.6%). Fracture rates varied from 37.67 to 107.18 per 1,000. The SSRIs citalopram (hazard ratio [HR] = 1.23; 95% confidence interval [CI] = 1.11-1.36 to HR = 1.43; 95% CI = 1.11-1.84) and sertraline (HR = 1.36; 95% CI = 1.10-1.68), the SNRI duloxetine (HR = 1.41; 95% CI = 1.06-1.88), TCAs doxepin (HR = 1.36; 95% CI = 1.00-1.86) and imipramine (HR = 1.16; 95% CI = 1.05-1.28), and atypicals (HR = 1.34; 95% CI = 1.14-1.58) increased fracture risk in some but not all jurisdictions. In the United States and the United Kingdom, fracture risk with all classes was higher when prescribed for depression than chronic pain, a trend that is likely explained by drug choice.
conclusionThe fracture risk for patients may be reduced by selecting paroxetine, an SSRI with lower risk than citalopram, the SNRI venlafaxine over duloxetine, and the TCA amitriptyline over imipramine or doxepin. There is uncertainty about the risk associated with the atypical antidepressants. J Am Geriatr Soc 68:1494-1503, 2020.
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