Healthy Skepticism Library item: 7866
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Publication type: news
Ravensbergen J.
Bone risk in drugs like Prozac
The Gazette (Montreal) 2007 Jan 23
http://www.canada.com/montrealgazette/news/story.html?id=7d1f24cf-3aa4-49b9-a57b-05ed562d7498&k=16111
Full text:
Antidepressants raise fracture odds in those over 50, study shows
Daily use of a widely prescribed class of antidepressants dramatically raises the risk of low-trauma bone fractures for adults age 50 or over, according to a study led by McGill University Health Centre researchers.
The condition is known as fragility fracture.
Those affected can break bones in their forearms, ankles and feet, hips, ribcage or elsewhere with a simple low-impact fall from standing height – or even during an ordinary action like trying to force open a sticky window.
The study evaluated the incidence of such fractures among users of Zoloft, Prozac, Paxil, Celexa and Lexapro.
“We’re not trying to make people stop taking these drugs,” Dr. David Goltzman, the study’s senior author and director of McGill’s Metabolic Bone Disease Centre, said yesterday after the report was released.
The study determined with a 95-per-cent confidence level that the risk of bone fracture is 2.1 times higher when these antidepressants are used on a daily basis by people 50 or over than when those drugs aren’t being used, Goltzman said.
These medications are known as selective serotonin re-uptake inhibitors, or SSRIs. “We looked at the class and not the individual drugs,” he added.
The study “certainly suggests very strongly that SSRIs can pre-dispose to fractures, probably by reducing the amount of bone and possibly by altering the quality of bone as well.”
The study also concluded that the odds of falling for those age 50 or more taking these drugs are 2.2 times greater than for those who don’t. SSRIs can cause a drop in blood pressure and fainting in some people.
As well, the study determined that bone-mineral density in the hips of SSRI users is four per cent lower than for non-users.
While SSRIs “are good drugs for depression,” Goltzman said, “patients and physicians should be aware there is an increased risk.”
Those 50 or older who take SSRIs “should pay particular attention to lifestyle issues,” he counselled, which include ensuring a diet rich in calcium and Vitamin D, “regular physical activity, no alcohol, no smoking.”
As well, “they probably should have a bone-mineral density (test) done before they start SSRIs – especially if they already have had a low-trauma fracture.
“And they probably should also have a bone-density (test) at two-year intervals after they start SSRIs. Their physician might also recommend specific treatment for osteoporosis.”
Brittle bones are a widespread problem among seniors.
Detailed questionnaires in 1996 and 2000 surveying adults age 50 or older who were taking SSRIs yielded a fracture rate of 13.1 per cent – 18 fractures among 137 adults, Goltzman said, rather than the “eight or nine fractures” that would be expected without SSRI use.
Such simple acts as opening a stuck window can also result in fractures among people with low bone-mineral density, Goltzman added.
The effects among SSRI users were found to be dose-dependent, Goltzman said: “The risk increases as the dose increases.”
The data were accumulated through the Canadian Multicentre Osteoporosis Study, launched in early 1996. It has been tracking more than 8,000 randomly selected adults, some from age 25.
The results were published in the journal Archives of Internal Medicine. The study was conducted in collaboration with researchers from McMaster University, Duke University and the University of British Columbia.
The use of SSRIs in the United States jumped 32 per cent between 2000 and 2004, with 2004 sales exceeding $10.9 billion U.S., Goltzman added. Such drugs are also widely prescribed in Canada.
janr@thegazette.canwest.com
