TY - JOUR
T1 - Prospective Association Between the Dispensing of Antidepressants and of Medications to Treat Osteoporosis in Older Age
AU - Almeida, Osvaldo P.
AU - Page, Amy
AU - Sanfilippo, Frank M.
AU - Etherton-Beer, Christopher
PY - 2024/3
Y1 - 2024/3
N2 - Background: Osteoporosis is a common condition associated with fragility fractures, especially in older individuals and women. Antidepressants have emerged as a potential risk factor, but their association with bone fragility remains uncertain because the results of past studies are difficult to generalize. We aimed to investigate the association between antidepressant exposure and subsequent treatment for osteoporosis in a nationally representative sample of Australians. Methods: Cohort study using a 10% random sample of the Pharmaceutical Benefits Scheme (PBS) data for 2012, that included 566,707 individuals aged older than or equal to 50 years not dispensed osteoporosis medications. The effect of exposure to antidepressants during 2012 (prevalent or incident) or later (up to 2022) was examined using Cox regression models adjusted for age, sex, comorbidities and other psychotropic medications. Results: Over 10 years, 73,360 (12.94%) received osteoporosis medications; 16,216 (22.10%) had been dispensed antidepressants in 2012. The hazard of osteoporosis medication dispensing was higher among those exposed to antidepressants (HR = 1.16, 99% CI = 1.14–1.18; average duration of follow up: 8.0 ± 3.1 years, range: 1–10 years). The hazard of osteoporosis medication diminished with increasing age, and the effect of antidepressants was 37%–76% more pronounced among men in the 50s and 60s. Different classes of antidepressants had a similar risk profile. Conclusion: The dispensing of antidepressants in older age is associated with higher hazard of subsequent dispensing of medications for osteoporosis, and this association is more marked for young older adults, particularly men. Clinicians should monitor the bone health of older individuals treated with antidepressants in order to decrease the morbidity associated with fragility fractures.
AB - Background: Osteoporosis is a common condition associated with fragility fractures, especially in older individuals and women. Antidepressants have emerged as a potential risk factor, but their association with bone fragility remains uncertain because the results of past studies are difficult to generalize. We aimed to investigate the association between antidepressant exposure and subsequent treatment for osteoporosis in a nationally representative sample of Australians. Methods: Cohort study using a 10% random sample of the Pharmaceutical Benefits Scheme (PBS) data for 2012, that included 566,707 individuals aged older than or equal to 50 years not dispensed osteoporosis medications. The effect of exposure to antidepressants during 2012 (prevalent or incident) or later (up to 2022) was examined using Cox regression models adjusted for age, sex, comorbidities and other psychotropic medications. Results: Over 10 years, 73,360 (12.94%) received osteoporosis medications; 16,216 (22.10%) had been dispensed antidepressants in 2012. The hazard of osteoporosis medication dispensing was higher among those exposed to antidepressants (HR = 1.16, 99% CI = 1.14–1.18; average duration of follow up: 8.0 ± 3.1 years, range: 1–10 years). The hazard of osteoporosis medication diminished with increasing age, and the effect of antidepressants was 37%–76% more pronounced among men in the 50s and 60s. Different classes of antidepressants had a similar risk profile. Conclusion: The dispensing of antidepressants in older age is associated with higher hazard of subsequent dispensing of medications for osteoporosis, and this association is more marked for young older adults, particularly men. Clinicians should monitor the bone health of older individuals treated with antidepressants in order to decrease the morbidity associated with fragility fractures.
KW - Antidepressants
KW - cohort study
KW - fractures
KW - monoamine oxidase inhibitor
KW - osteopenia
KW - osteoporosis
KW - SSRI
KW - tricyclics
UR - http://www.scopus.com/inward/record.url?scp=85175309033&partnerID=8YFLogxK
U2 - 10.1016/j.jagp.2023.10.004
DO - 10.1016/j.jagp.2023.10.004
M3 - Article
C2 - 37919102
AN - SCOPUS:85175309033
SN - 1064-7481
VL - 32
SP - 349
EP - 357
JO - American Journal of Geriatric Psychiatry
JF - American Journal of Geriatric Psychiatry
IS - 3
ER -