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Antidepressants Can Increase Fracture Risk

Jul 15, 2008 | Parker Waichman Alonso LLP

More and more studies are indicating that antidepressants such as Paxil and Prozac are putting older people at increased risk for fractures.  As a matter-of-fact, in one of the more recent reports, Leslie Spangler, a researcher at Group Health, a Seattle-based health plan, discovered that antidepressant use in postmenopausal women—those who averaged around 64 years of age—was linked to an increased risk of fractures of the spine and other sites.  "Our study didn't show any strong association between antidepressants and wrist fractures and hip fractures," she said. "It did find an association with spine fracture."

In that study, the women taking antidepressants experienced a 30 percent increased risk of spine fracture and a 20 percent increased risk of any type of fracture, according to Spangler.  Spangler's team based its findings on a review of data from over 93,000 women enrolled in the large Women’s Health Initiative Observational Study.  For the review, the researchers looked at antidepressant use and then at the incidence of fracture.  The study’s findings were published in the May issue of the Journal of General Internal Medicine.  In an earlier study, Dr. David Goltzman, director of the McGill Centre for Bone and Periodontal Research at McGill University in Montreal, Canada, reviewed data from an osteoporosis study that included over 5,000 randomly selected people, including 137 who took those antidepressants which are known as selective serotonin reuptake inhibitors—SSRIs—on a daily basis.  That research revealed that daily SSRI users had twice the risk of bone fracture as those not taking SSRIs.  While the studies suggest an association between antidepressant use and fractures, no research has found a cause-and-effect relationship, Spangler said.

Serotonin is a brain chemical linked to depression and is also involved in the physiology of the bone, said Goltzman, who also said that if you change that system, you can get low bone density, which boosts fracture risk.  Goltzman’s research was published in 2007 in the Archives of Internal Medicine.  Goltzman reported that he and his colleagues are now looking at teenagers who take SSRIs, to determine if any effects from the drugs on growing bones are revealed and are also looking to see if there is a “genetic predilection” for osteoporosis that’s induced by the antidepressants.  Osteoporosis is the brittle bone disease that can lead to fractures.

Charlie McAtee, a spokesperson for Eli Lilly and Company, maker of the SSRI antidepressant Prozac (fluoxetine), agreed with Spangler and said that "the current data does not allow a definitive conclusion that fluoxetine contributes significantly to the risk of osteoporosis and fractures in fluoxetine-treated patients."  But, McAtee agreed that the osteoporosis-antidepressant link has been seen before, saying, "The Prozac label does list osteoporosis as an event observed in clinical trials."

Goltzman suggests, "I would advise individuals on SSRIs not to stop their medication if they are receiving the drugs for valid reasons. They should, however, strongly consider seeing their physician to be evaluated for osteoporosis, including having a bone density test done."