Risk of osteoporotic fractures in menopausal women with common mental health diagnoses prescribed SSRIs/SNRIs: cohort and self-controlled case series analyses

Dana Alsugeir; Matthew Adesuyan; Christina Avgerinou; Vikram Talaulikar; Li Wei; Ruth Brauer

doi:10.1007/s11657-024-01459-3

Risk of osteoporotic fractures in menopausal women with common mental health diagnoses prescribed SSRIs/SNRIs: cohort and self-controlled case series analyses

Arch Osteoporos. 2024 Oct 23;19(1):100. doi: 10.1007/s11657-024-01459-3.

Authors

Dana Alsugeir^{1

2}, Matthew Adesuyan¹, Christina Avgerinou³, Vikram Talaulikar⁴, Li Wei¹, Ruth Brauer⁵

Affiliations

¹ Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP, UK.
² Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
³ Department of Primary Care and Population Health, University College London, London, UK.
⁴ Reproductive Medicine Unit, University College London Hospital, London, UK.
⁵ Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP, UK. r.brauer@ucl.ac.uk.

Abstract

In a population-based cohort study of menopausal women with common mental health diagnoses, SSRIs/SNRIs were associated with a 32% increased risk of osteoporotic fractures. The risk of osteoporotic fractures was particularly increased for longer periods of treatment with SSRIs/SNRIs (> 5 years) and in younger menopausal women (< 50 years old).

Purpose: To investigate the association between selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and the risk of osteoporotic fractures (OF) in menopausal women with common mental health diagnoses (CMHD).

Methods: We conducted the study with two designs (cohort and self-controlled case series [SCCS]), using the IQVIA Medical Research Database (IMRD) UK. The source population comprised women aged ≥ 50 years and women with a record indicating menopause (< 50 years). All women had a recorded CMHD. For the cohort analysis, the risk of OFs was estimated by comparing women prescribed SSRIs/SNRIs (exposed) to those not exposed. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CIs). For the SCCS, women acted as their own controls; periods of exposure to SSRIs/SNRIs were compared to periods of non-exposure using conditional Poisson regression to estimate incidence rate ratios (IRR) with 95% CIs.

Results: We identified 292,848 women, of whom 35,222 experienced OFs within a median follow-up of 6.01 years. We found strong evidence of an association between SSRIs/SNRIs and the risk of OFs (adjusted HR = 1.32, 95% CI:1.29-1.35). Compared to periods of no exposure, SSRIs/SNRIs increased the risk of OFs during the first 30 days (IRR = 1.38, 95% CI:1.26-1.51), during the first 90 days (IRR = 1.58, 95% CI: 1.48-1.69), and the remaining exposure (IRR = 1.42, 95% CI:1.37-1.48).

Conclusions: In a population of menopausal women with CMHDs, the prescribing of SSRIs/SNRIs antidepressants was associated with a higher risk of OFs. Careful assessment of osteoporosis risk needs to be considered when treating menopausal women with SSRIs/SNRIs antidepressants.

Keywords: Fractures; Menopausal; Osteoporosis; SSRIs/SNRIs.

MeSH terms

Aged
Cohort Studies
Female
Humans
Menopause*
Mental Disorders / drug therapy
Mental Disorders / epidemiology
Middle Aged
Osteoporotic Fractures* / epidemiology
Risk Factors
Selective Serotonin Reuptake Inhibitors* / adverse effects
Selective Serotonin Reuptake Inhibitors* / therapeutic use
Serotonin and Noradrenaline Reuptake Inhibitors / adverse effects
Serotonin and Noradrenaline Reuptake Inhibitors / therapeutic use
United Kingdom / epidemiology

Substances

Selective Serotonin Reuptake Inhibitors
Serotonin and Noradrenaline Reuptake Inhibitors