Norwegian winters pose an extra challenge for the elderly who are afraid of slipping and falling. (Photo: Colourbox)

Elderly on antidepressants more likely to fracture hips

Hundreds of serious bone fractures in Norway among the elderly can be linked to the antidepressants used to treat their depression.

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Older people who take antidepressant drugs are twice as likely to fracture a hip as their peers who don’t use these medications.

A type of so-called happy pills, known medically as selective serotonin reuptake inhibitors (SSRIs), are linked to the highest risk of bone fractures, according to a nationwide prospective cohort study covering a six year period and all the elderly born before 1945.

Some 9,000 hip fractures occur in Norway annually, which makes the country with its population of 5 million the unfortunate world leader per capita.

“Hip fractures among the elderly who use SSRI medications are even more common than we thought. The drug can have a good effect, but also has some unfortunate side effects,” says Marit Stordal Bakken. Bakken is a doctor and researcher at the University of Bergen and the Kavli Research Centre for Ageing and Dementia at Haraldsplass Diaconal Hospital.

Marit Stordal Bakken. (Photo: Ida Kristine Sangnes)

“The risk of a fracture is nearly double,” she says.

Earlier findings had already suggested this. Researchers in the Netherlands found in a study from 2012 that elderly people who suffer from dementia are three times more likely to take a fall if they use SSRIs.

Closer attention to who gets the pills

Stordal Bakken and her colleagues have correlated data from the Norwegian Prescription Database and the Norwegian Hip Fracture Registry for the years 2005 through 2010, for all individuals aged 60 and up.

The researchers calculated that nearly 5 percent of the hip fractures in these years, or about 1,900 in total, could be linked to the use of antidepressants.

Their point of departure was all 39,938 initial fractures for the entire period. That means if a person broke a hip more than once, only the first was included in the study. 

Important findings

Even though the connection between hip fractures and use of these medications is clear, the cohort study didn’t provide the researchers with any direct cause-and-effect insights.

“Still, the findings are important. We’ve documented that a lot of older people who take antidepressants are fracturing their hips. They are over-represented in the statistics when compared to those who don’t take the medication.”

“This should make MDs pay closer attention to which of the elderly they are prescribing these drugs,” says Stordal Bakken.

She points out that in 2011, the Norwegian Medicines Agency recommended that doctors lower the doses of SSRIs they were prescribing to the elderly, after seeing that high doses were causing arrhythmias, or irregular heartbeats.

Instability and osteoporosis

Hip fractures among the elderly are commonly caused by a fall combined with lower bone density, or osteoporosis. 

Stordal Bakken thinks antidepressants might make the elderly more prone to falls by disturbing their balance or stability as well as weakening their bone tissue, thus making fractures more likely. 

“Some studies have found that the elderly can lose their balance in the electrolyte system when SSRI medications are used. This can contribute to confusion and instability.”

“Other researchers have also found that modern antidepressants have a direct effect on bone tissue,” says Stordal Bakken.

Too much?

The researcher explains that it’s now quite common to prescribe antidepressants to the elderly, and SSRIs are the most commonly prescribed.

Stordal Bakken says it's not neccessarily that SSRIs are being prescribed too readily.

“The issue is more a matter of whether they are used correctly. We shouldn’t underestimate depression among the elderly. But we doctors have to be particular about making the right diagnoses. We need to make sure we are treating depression, not just loneliness or a sense of loss.”

“It’s important to keep in mind treatment methods that have no side effects, such as efforts to improve people’s social situation, or light therapy and cognitive therapy,” she says.

The study also showed a stronger link between the use of these drugs and hip fractures among men than among women. 

The researchers behind the study point out that because fractured hips and the use of antidepressants are less prevalent among men than women, any exposure to the drugs are relatively more likely to have a effect on the risk of such fractures.

Translated by: Glenn Ostling

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