SSRIs used for menopausal symptoms may increase bone fracture risk

Middle-aged women who take antidepressant selective serotonin reuptake inhibitors (SSRIs) to treat menopausal symptoms may “significantly” increase their risk of bone fracture, according to research published in Injury Prevention
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on 25 June 2015. 

For the first time, researchers looked at whether the risk of fracture was increased for perimenopausal women who take SSRIs compared with a similar group of women without mental disorders. They compared the fracture rates of the hip, humerus, radius and ulna in two cohorts of women. 

One group comprised 137,031 women aged between 40–64 years with no mental health issues who had taken SSRIs, while the second group involved 236,294 women prescribed H2 antagonists (H2A) or proton pump inhibitors (PPI). None of the women had a psychiatric disorder. 

Researchers decided to include women prescribed H2As because they said previous studies had shown that this patient group have a “trivial or no association” with risk of fracture and women prescribed PPIs have been shown to have a slight increased risk of fracture. 

They found that fracture rates were “significantly” higher amongst the SSRI group and that the risk was sustained for a five-year period. The fracture rate was 76% higher in the SSRI group compared with the H2A/PPI group one year after starting treatment; 73% higher after two years and 67% after five years. 

“SSRIs appear to increase fracture risk among middle-aged women without psychiatric disorders, an effect sustained over time, suggesting that shorter duration of treatment may decrease fracture risk,” say the researchers. “Future efforts should examine whether this association pertains at lower doses.”