Background: Prior studies have reported an increased risk of fracture in patients taking antidepressants drug, and antidepressants use is associated with bone loss and increased risk of falls; however, whether increased incident fracture risk associated with antidepressants use is independent of falls risk and body mineral density (BMD) remains unclear.
Objective: To examine whether the association between antidepressants use and incident fracture risk is independent falls risk and BMD.
Methods: Data from a longitudinal population-based study of older adults (mean age 63 years) were utilised. Follow-up was performed at 2.6-, 5.1- and 10.7-year later, respectively. The reported use of antidepressants drug was collected at baseline. Fractures were self-reported at each time-point. BMD was measured by Dual-energy X-ray absorptiometry. Falls risk was calculated based on the short form Physiological Profile Assessment. Log-binomial regression was used for the analyses.
Results: Among 1012 participants, 159 reported the use of antidepressants at baseline. A total of 153 reported new fractures during a mean follow-up of 10.7-year, of whom 20 experienced a vertebral fracture, 134 a non-vertebral fracture and three a hip fracture. In multivariable analysis with adjustment for age, sex, physical activity, smoking history, comorbidities and emotional problems, antidepressants use was associated with an increased risk of incident fracture at any site [relative risk (RR) 1.87, 95%confidence intervals (CI) 1.25-2.78], vertebral (RR 5.88, 95%CI 2.32-14.88) and major (including the femur, radius, ulnar, vertebral, rib and humerus) (RR 2.22, 95%CI 1.21-4.09). After further adjustment for hip BMD and falls risk, these associations remained statistically significant. There was no significant association for non-vertebral fracture, and hip fracture risk cannot be estimated due to only three incident hip fracture.
Conclusion: Antidepressants use is associated with increased risk of incident fracture, independent of falls risk, BMD and confounders highlighting that optimal management of antidepressants use may prevent fracture.