Antidepressants Associated with Increased Fracture Risk in Menopausal Women

A recent study suggests women prescribed selective serotonin reuptake inhibitors (SSRIs) could be at higher risk for bone fractures—even years after they stop taking the drugs.

Our Manhattan practice offers holistic options and skilled medical treatment to patients so they can make their best health choices. Part of our mandate is education. For our patients moving through menopause, that means alerting you to information that could affect your health.

In research published online in the June issue of Injury Prevention, study authors compared medical data on more than 235,000 women between 40 and 64 years of age. The study looked for health associations between two groups—those prescribed SSRIs, and those prescribed drugs used to treat indigestion.

The women involved in the study were treated for symptoms related to menopause, not for symptoms of any mental disorder.

What are SSRIs?

SSRIs are antidepressants, and work to address brain chemistry that can lead to depression, and depressive symptoms. In this study, the generic names of the types of SSRIs studied include:

• Italopram
• Hyrdrobromide
• Escitalopram oxalate
• Fluoxetine hyrdrochloride
• Fluvoxamine maleate
• Paroxetine hydrochloride
• Sertraline hydrochloride

These drugs are marketed under brand names like Zoloft, Prozac, Paxil, and Celexa. Antidepressants are the third most common type of drug prescribed in the U.S., and often for uses that are not psychiatric in nature.

In June, 2013, the Food and Drug Association (FDA) approved paroxetine as the first non-hormone based treatment for hot flashes related to menopause. Antidepressants are sometimes prescribed to treat symptoms of menopause including hot flashes, irritable bowel syndrome, and night sweats.

Reason for Concern if You Take SSRIs

The data collected for this study came from the PharMetrics Claims database, an information resource that tracks drug treatments of more than 60 million patients across the country. Researchers focused on women in the target age range who began SSRI treatment for menopause symptoms between the years 1998 and 2010.

The study was looking to discover if there was an increased risk of bone fracture among women prescribed SSRIs who did not have a mental disorder. Medical literature has previously identified an increased risk of bone fracture among women taking SSRIs for their primary use—depression.

During the study term, researchers learned the following key information:

• For women prescribed SSRIs, the risk of bone fracture is 76 percent higher after one year of treatment
• After two years, the increased risk dropped to 73 percent
• Within five years of taking SSRIs, the risk of bone fracture was still 67 percent higher than women prescribed the drugs for indigestion

The study concludes, “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.”

In their discussion, study authors suggest an association between SSRIs and an increase in osteoclastic behavior. This means SSRIs could increase the rate at which bones replace themselves. The result of altering the cycle of bone renewal could be thins bones, and lower bone mineral density—making patients more susceptible to fracture.

As this was an observational study, the research suggests—but doesn’t prove—an association between taking SSRIs and an increased chance of breaking a bone. More studies will be needed to prove the link.

But at any age, a broken bone is serious. Over 40 years of age, a broken bone could lead to lasting disability, or a shortened life span.

In the meantime, there are other options besides SSRIs to treat menopausal symptoms. So if you are someone at risk for osteoporosis, be sure to discuss your options with your physician.

Risk Factors for Osteoporosis/Bone Fractures

• Being an older woman of white or Asian descent
• Family history of osteoporosis
• Small body frame
• Low estrogen
• Hyperthyroidism
• Overactive parathyroid
• Overactive adrenal glands
• Low calcium intake
• History of eating disorders
• History of gastrointestinal surgery
• Long-term use of oral or injected steroid medications
• Sedentary lifestyle
• Excessive alcohol consumption
• Tobacco use