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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SSRIs and fracture risk

A recent article discussed the link found between proton pump inhibitors and increased hip fracture risk, now a paper in the Archives of Internal Medicine has identified an association between clinical fragility fracture and daily selective serotonin reuptake inhibitor (SSRI) use.

The study collected data for 5,008 patients aged 50 years and older over a 5-year period. Clinical fragility fractures were identified if radiographically confirmed. Daily SSRI use was report in 137 patients and after adjusting for several covariates the hazard rate was calculated to be 2.1 [95% CI 1.3-3.4]. There were also associations with falls and lower bone mineral density at the hip.

There are potential confounders in the study. Patients with depression may be less likely to eat a well balanced diet. These patients may also have depression as the consequence of chronic co-morbidity.

Action: Clinicians should be aware of the possible increased fracture risk with SSRIs. Depression should still be appropriately treated and fragility fracture risk managed with dietary advice and treatment where appropriate.

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