Antidepressants Put Elderly at Fracture Risk

Jan. 22, 2007 — -- Elderly patients who take antidepressant drugs known as selective serotonin reuptake inhibitors, or SSRIs, may be doubling their risk of fractures from falls, a new study suggests.

The class of drugs includes the popular depression drugs Prozac and Paxil. These drugs are considered first-line therapy for treatment of depression in older adults.

And because about one in 10 elderly primary care patients in the United States suffers from depression, thousands could be affected.

The study appears in the current issue of Archives of Internal Medicine.

"What we found was that there was a twofold risk of clinical fractures in these elderly patients, and this is over and above the fact that they already had other risk factors for fractures," said study co-author Dr. David Goltzman of the department of medicine at McGill University in Montreal.

Goltzman said the fractures studied in this case were low-trauma -- so named because they occurred as a result of stress put on the bones from minor impacts or even day-to-day activities such as walking or standing up.

The findings, if accurate, may reveal how much researchers and physicians have yet to learn about this class of drugs.

"There has really not been very much research done on the effect of many drugs on bone formation, and this is true of SSRIs," said Dr. James Powers, geriatrician and associate professor at Vanderbilt University Medical Center.

"We know that SSRIs are associated with increased risk of falls, and sometimes the physician is faced with the very difficult choice of having to decide whether to treat depression and deal with the consequences of increased fall risk."

So must elderly patients suffering from depression choose between their mental health and their hips?

Unlikely, Goltzman said.

"I wouldn't recommend that patients go off these medicines if they need them," he said. "But they should just be aware of the increased risk for fractures and take steps to minimize their chances of experiencing fractures in the future."

Powers agreed that in most cases, clinical practice for elderly depressed patients should not be changed. But he said an individual approach to each case is necessary to determine the best course of action.