Serotonin–Norepinephrine Reuptake Inhibitor and Selective Serotonin Reuptake Inhibitor Use and Risk of Fractures: A New-User Cohort Study Among US Adults Aged 50 Years and Older

Feb 25, 2015CNS drugs

Use of serotonin and serotonin-norepinephrine antidepressants and fracture risk in US adults aged 50 and older

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Abstract

Fracture rates were approximately equal in patients initiating selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

The study analyzed data from 335,146 SSRI initiators and 61,612 SNRI initiators aged 50 years or older.
Hazard ratios for fractures during the first year and fifth year after initiation were 1.11 and 1.06, respectively, indicating similar fracture rates for both drug classes.
In a subgroup of patients with depression, those starting on SNRIs showed a modestly elevated fracture risk compared to SSRI initiators, with a hazard ratio of 1.31.
There was no evidence suggesting that starting SNRIs significantly affects fracture risk compared to SSRIs in middle-aged and older adults.

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BACKGROUND: Antidepressants may increase the risk of fractures by disrupting sensory-motor function, thereby increasing the risk of falls, and by decreasing bone mineral density and consequently increasing the fall- or impact-related risk of fracture. Selective serotonin reuptake inhibitor (SSRI) antidepressants appear to increase fracture risk relative to no treatment, while less is known about the effect of serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants, despite SNRIs being prescribed with increasing frequency. No prior study has directly examined how fracture risk differs among patients initiating SNRIs versus those initiating SSRIs.

OBJECTIVE: The objective of this study was to assess the effect of SNRI versus SSRI initiation on fracture rates.

DATA SOURCE: Data were derived from a PharMetrics claims database, 1998-2010, which is comprised of commercial health plan information obtained from managed care plans throughout the US.

METHODS: We constructed a cohort of patients aged 50 years or older initiating either of the two drug classes (SSRI, N = 335,146; SNRI, N = 61,612). Standardized mortality weighting and Cox proportional hazards regression were used to estimate hazard ratios (HRs) for fractures by antidepressant class.

RESULTS: In weighted analyses, the fracture rates were approximately equal in SNRI and SSRI initiators: HRs for the first 1- and 5-year periods following initiation were 1.11 [95 % confidence interval (CI) 0.92-1.36] and 1.06 (95 % CI 0.90-1.26), respectively. For the subgroup of patients with depression who initiated on either SNRIs or SSRIs, those initiating SNRIs had a modestly, but not significantly, elevated fracture risk compared with those who initiated on SSRIs [HR 1.31 (95 % CI 0.95-1.79)].

CONCLUSIONS: We found no evidence that initiating SNRIs rather than SSRIs materially influenced fracture risk among a cohort of middle-aged and older adults.

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Serotonin–Norepinephrine Reuptake Inhibitor and Selective Serotonin Reuptake Inhibitor Use and Risk of Fractures: A New-User Cohort Study Among US Adults Aged 50 Years and Older

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