Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort

• Published in: Osteoporosis international Vol. 27; no. 11; pp. 3187 - 3195
• Main Authors: Carrière, I., Farré, A., Norton, J., Wyart, M., Tzourio, C., Noize, P., Pérès, K., Fourrier-Réglat, A., Ancelin, M. L.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-11-2016; Springer Nature B.V
• Subjects: Accidental Falls; Aged; Antidepressants; Antidepressive Agents - administration & dosage; Citalopram; Cohort Studies; Endocrinology; Falls; Female; Fluoxetine; Fractures; Fractures, Bone - epidemiology; Geriatrics; Humans; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Mental depression; Original Article; Orthopedics; Proportional Hazards Models; Rheumatology; Risk Factors; Serotonin uptake inhibitors; Serotonin Uptake Inhibitors - administration & dosage; Falls; Fractures; Antidepressants; Elderly
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-016-3667-7

Summary
In this population-based elderly cohort, participants using selective serotonin reuptake inhibitor (SSRI) antidepressants have an increased risk of falls and fractures notably when the treatment was continued over 4 years. Among the various SSRI types, citalopram only was at significant risk for falls and fluoxetine for fractures.
Introduction
Increased risk of falls and fractures has been reported in elderly users of SSRIs. However, biases were insufficiently addressed notably temporality between exposure and outcome and confounding by residual depression. Our objective was to examine the associations between SSRIs and fall or fracture incidence focusing on their chronic use and different types of SSRIs.
Methods
The population-based cohort included participants aged 65 years and above, who had not fallen before inclusion (
n
 = 6599) or were free of recent fracture (
n
 = 6823) and were followed up twice over 4 years. New fall and fracture events were self-reported and defined as at least two falls and one fracture, respectively, during the previous 2 years. SSRI users were compared with those taking no antidepressants. Hazard ratios (HRs) were estimated using Cox models with delayed entry and adjusted for many confounders including residual depressive symptoms.
Results
Incidence of falls was 19.3 % over 4 years and that of fractures 9.5 %. After multi-adjustment, SSRI intake was significantly associated with a higher risk of falls (HR, 95 % CI = 1.58, 1.23–2.03) and fractures (HR, 95 % CI = 1.61, 1.16–2.24). The risks were significantly increased by 80 % in those continuing the treatment over 4 years. Citalopram intake only was at significant risk for falls and fluoxetine for fractures.
Conclusions
In this large community-dwelling elderly sample, SSRI users were at higher risk of falls and fractures. This association was not due to reverse causality or residual depressive symptoms. Different SSRI drugs may have specific adverse effects on falls and fractures.