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Antidepressants linked to fractures, but don't panic, docs say

February 12, 2007|by JULIE E. GREENE

Although a study has linked a class of common antidepressant drugs to a greater chance of fractures in older people, people shouldn't just stop taking the medicine, medical experts said.

While medical experts dispute whether a consistent link has been proven after several studies, they agree that people on the prescription drug should discuss possible side effects with their doctors and weigh those effects against the benefits of the drug. And senior citizens should, if they haven't already, get a bone density scan, experts said.

The drugs linked to greater chance of fractures in older people are selective serotonin reuptake inhibitors, also known as SSRIs.

Findings from a study led by researchers at McGill University Health Centre in Montreal, published in the Jan. 22 issue of Archives of Internal Medicine, suggest people 50 and older who take SSRIs daily for depression double their risk of bone fractures, according to a news release at McGill University's Web site, www.mcgill.ca.

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One of the findings from a study done a few years ago was that the use of SSRIs among men 65 and older was associated with a 4-percent decrease in bone mineral density levels. The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Institute on Aging (NIA).

It's possible to stop taking SSRIs and still feel good for a while because the drug stays in the body for a while, said Shelly Malone, nurse manager of Gateway Behavioral Health at City Hospital in Martinsburg, W.Va. But over time the therapeutic level of the drug will drop off and the person will become depressed again, Malone said.

Depression reduces the chances for surviving many illnesses or medical conditions, including heart attack, strokes and fractures, according to Dr. Cynthia Kuttner-Sands, a geriatrician at Washington County Hospital in Hagerstown. A small percentage of people with depression attempt suicide.

"A fractured hip is awful, don't get me wrong, but still it can be fixed. Suicide can't. That's the end of the road," Malone said.

Older people in general tend to have more brittle bones and fall more often, Malone said. There's also a disproportionate number of suicides among that age group.

Nineteen percent of suicide deaths in 1998 in the U.S. were people 65 or older, Malone said. That year, 13 percent of the U.S. population was in that age group.

Kuttner-Sands said older people can be more determined when it comes to attempting suicide and they are more successful because they often have prescription drugs they can use to overdose.

Kuttner-Sands and Dr. Ralph Salvagno, an orthopedic surgeon at the Center for Joint Surgery & Sports Medicine at Robinwood Medical Center east of Hagerstown, said there isn't enough data yet to confirm a link between SSRIs and an increased risk of bone fractures.

"If someone is depressed, they need to be treated and I wouldn't deny them an antidepressant because of increased risk of hip fracture," Kuttner-Sands said.

She also wouldn't recommend someone delay going on SSRIs until they get a bone density scan.

Bone density and osteoporosis

Kuttner-Sands and Salvagno said older people should talk to their doctor about whether they need to get a bone density scan, regardless of whether they are on SSRIs or not.

"The biggest problem with osteoporosis is it's unrecognized," Salvagno said.

Often people only find out they have osteoporosis after they break a bone, when an earlier diagnosis could lead to treatment to help prevent fractures, Salvagno said.

A bone density scan, similar to an X-ray, helps assess a person's risk for osteoporosis. The density is usually checked at the spine and hip.

Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, according to the National Osteoporosis Foundation. It can lead to fragile bones and an increased chance of fractures, especially of the hip, spine and wrist.

Osteoporosis is not age-related. It is found in young people with a family history of the disease, Salvagno said.

Medical experts said medications that have been linked to osteoporosis include thyroid medications; some anti-seizure medications; methotrexate, which is prescribed for rheumatoid arthritis; and steroids such as prednisone.

These medications can interfere with the creation of new bone tissue or accelerate the absorption of bone tissue back into the body, leading to osteoporosis, Salvagno said.

Smoking and alcohol also can contribute to osteoporosis, he said. Early menopause or a hysterectomy also can lead to osteoporosis due to the decrease in estrogen levels.

The easiest ways to treat osteoporosis are increasing weight-bearing exercise and the boosting the intake of calcium and vitamin D. The three medications most often prescribed for osteoporosis are bisphosphonates such as Fosamax, Boniva and Actonel.

SSRIs

SSRIs are the most commonly prescribed medication for depression, Malone said.

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