@article{ref1,
title="Serotonin-norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor use and risk of fractures: a new-user cohort study among US adults aged 50 years and older",
journal="CNS drugs",
year="2015",
author="Lanteigne, Amy and Sheu, Yi-Han and Stürmer, Til and Pate, Virginia and Azrael, Deborah R. and Swanson, Sonja A. and Miller, Matthew",
volume="29",
number="3",
pages="245-252",
abstract="BACKGROUND: Antidepressants may increase the risk of fractures by disrupting sensory-motor function, thereby increasing the risk of falls, and by decreasing bone mineral density and consequently increasing the fall- or impact-related risk of fracture. Selective serotonin reuptake inhibitor (SSRI) antidepressants appear to increase fracture risk relative to no treatment, while less is known about the effect of serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants, despite SNRIs being prescribed with increasing frequency. No prior study has directly examined how fracture risk differs among patients initiating SNRIs versus those initiating SSRIs. <br><br>OBJECTIVE: The objective of this study was to assess the effect of SNRI versus SSRI initiation on fracture rates. DATA SOURCE: Data were derived from a PharMetrics claims database, 1998-2010, which is comprised of commercial health plan information obtained from managed care plans throughout the US. <br><br>METHODS: We constructed a cohort of patients aged 50 years or older initiating either of the two drug classes (SSRI, N = 335,146; SNRI, N = 61,612). Standardized mortality weighting and Cox proportional hazards regression were used to estimate hazard ratios (HRs) for fractures by antidepressant class. <br><br>RESULTS: In weighted analyses, the fracture rates were approximately equal in SNRI and SSRI initiators: HRs for the first 1- and 5-year periods following initiation were 1.11 [95 % confidence interval (CI) 0.92-1.36] and 1.06 (95 % CI 0.90-1.26), respectively. For the subgroup of patients with depression who initiated on either SNRIs or SSRIs, those initiating SNRIs had a modestly, but not significantly, elevated fracture risk compared with those who initiated on SSRIs [HR 1.31 (95 % CI 0.95-1.79)]. <br><br>CONCLUSIONS: We found no evidence that initiating SNRIs rather than SSRIs materially influenced fracture risk among a cohort of middle-aged and older adults.<p /> <p>Language: en</p>",
language="en",
issn="1172-7047",
doi="10.1007/s40263-015-0231-5",
url="http://dx.doi.org/10.1007/s40263-015-0231-5"
}