Association between use of antidepressants or benzodiazepines and the risk of subsequent fracture among those aged 65+ in the Netherlands

• Published in: Osteoporosis international Vol. 29; no. 11; pp. 2477 - 2485
• Main Authors: van de Ven, L. I., Klop, C., Overbeek, J. A., de Vries, F., Burden, A. M., Janssen, P. K.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-11-2018; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Antidepressants; Antidepressive Agents - adverse effects; Benzodiazepines; Benzodiazepines - adverse effects; Databases, Factual; Drug Utilization - statistics & numerical data; Endocrinology; Female; Follow-Up Studies; Fractures; Health risk assessment; Hip; Hip Fractures - chemically induced; Hip Fractures - epidemiology; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Netherlands - epidemiology; Original; Original Article; Orthopedics; Osteoporosis; Osteoporotic Fractures - chemically induced; Osteoporotic Fractures - epidemiology; Recurrence; Rheumatology; Risk Assessment - methods; Surgeons General; Netherlands; Major osteoporotic fracture; Hip fracture; Subsequent fracture; Antidepressants; Benzodiazepines
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-018-4632-4

Summary
This is the first study to examine the association between antidepressant and benzodiazepine use following a MOF and risk of subsequent fracture in those 65+. Using national data, drug use following MOF showed that the 1-year fully adjusted risk of subsequent MOF in those on antidepressants was more than doubled.
Introduction
We evaluated the association between the use of antidepressants or benzodiazepines and the risk of a subsequent major osteoporotic fracture.
Methods
A cohort study was performed using the Dutch PHARMO Database Network. Between 2002 and 2011, a total of 4854 patients sustained a first major osteoporotic fracture after the age of 65 years, of which 1766 sustained a hip fracture. Incidence rates and adjusted hazard ratios were calculated using Cox proportional hazards models.
Results
Within 1 year following a major osteoporotic fracture, 15% (95% CI 13.7–15.7) and 31% (95% CI 30.1–32.8) of patients were dispensed an antidepressant or benzodiazepine, respectively. Current use of antidepressants in the first year following a major osteoporotic fracture was associated with subsequent fracture (adjusted HR 2.17 (95% CI 1.37–3.43)). Recent and past use of antidepressants were also associated with an increased risk of subsequent fracture. When the complete follow-up period was included, only the current use of antidepressants was associated with subsequent fracture following a major osteoporotic fracture (adjusted HR 1.48; 95% CI 1.06–2.06). Current benzodiazepine use was not associated with an increased risk of fracture within 1 year following a major osteoporotic fracture (adjusted HR 1.18; 95% CI 0.76–1.81) or during the complete follow-up period (adjusted HR 1.18; 95% CI 0.90–1.55).
Conclusion
This study provides evidence that antidepressants should be used with caution following a major osteoporotic fracture. It provides needed insights that can be used to inform clinicians when assessing subsequent fracture risk in patients.