Antidepressant use is tied to nearly double the risk of sustaining a hip fracture among community-dwelling elderly people, particularly those with Alzheimer’s disease, according to a new study from the University of Eastern Finland. The increased risk was highest when the patients first began antidepressant treatment but remained elevated even four years later.
The increased risk was associated with all of the most frequently used antidepressant groups, including selective serotonin reuptake inhibitors (SSRIs), mirtazapine and selective noradrenaline reuptake inhibitors (SNRIs). Since antidepressants are prescribed not only for the treatment of depression, but also for chronic pain and behavioral and psychological symptoms of dementia — including insomnia, anxiety, and agitation — their use is quite common among the elderly.
The falls and subsequent fractures may be linked to certain antidepressant side effects, such as confusion, sedation, arrhythmia, orthostatic hypotension (decreased blood pressure within minutes of standing), and/or hyponatremia (abnormally low levels of sodium in blood).
For the study, each person with Alzheimer’s disease was matched by age and sex to two controls without the disease. The mean age of the study population was 80 years. Antidepressant use was associated with two times higher risk of hip fracture among controls. However, the relative number of hip fractures was higher among persons with Alzheimer’s disease compared to controls.
The link between antidepressant use and the increased risk of hip fracture remained even after adjusting for patients’ use of other medications increasing the risk of fall, osteoporosis, socioeconomic status, history of psychiatric diseases, and other chronic diseases increasing the risk of fall or fracture.
If antidepressant use is necessary among elderly patients, the researchers recommend that the medication and its original purpose be monitored regularly. Furthermore, other risk factors for falling should be carefully considered before administering antidepressant treatment.
The study data was pulled from the register-based MEDALZ cohort which included all community-dwelling persons diagnosed with Alzheimer’s disease in Finland between 2005-2011, and their matched controls. The study population included 50,491 persons with Alzheimer’s disease and 100,982 persons without the disease. The follow-up was four years from the date of Alzheimer’s disease diagnosis or a corresponding date for controls.
Alzheimer’s disease is increasing worldwide. Currently, about 42 million people have dementia, with Alzheimer’s disease being the most common type.
The findings are published in the International Journal of Geriatric Psychiatry.
Source: University of Eastern Finland