Tag Archive | Menopause

Bone Fracture-SSRI Link in Perimenopausal Women

The prescribing of selective serotonin reuptake inhibitors (SSRIs) for nonpsychiatric disorders has climbed steadily in recent years, and the June 2013 FDA approval of paroxetine to treat hot flashes associated with menopause is likely to expose more women to this popular class of antidepressants.

A new observational, claims-based analysis found that 137,000 women between the ages of 40 and 64 without mental illness who started an SSRI between 1998 and 2010 were 67% to 76% more likely to break a bone during the subsequent one to five years than 236,000 women of the same age who took indigestion drugs during the same time period. The analysis allowed for a six-month lag time to account for a presumed delay in the clinical effects of SSRIs on bone density. All told, the findings suggest that “shorter duration of treatment might mitigate the risk of developing excess fractures,” co-author Yi-han Sheu told MedPage Today.

Noting that the study did not account for varying dosages of SSRIs, Holly Puritz, MD, a spokesperson for the American College of Obstetricians and Gynecologists, told MedPage Today, “Overall fracture rates are extremely low in this age group, so noting an increase can look significant when discussed as a percentage, but [is] less meaningful when actual numbers are looked at.” And then there’s this possibly confounding factor: A study reported on in OrthoBuzz earlier this year found that hot flashes in and of themselves were associated with an increased risk of hip fractures in women.

Hot Flashes Linked to Increased Risk of Hip Fracture in Women

Menopausal women who experience moderate to severe hot flashes are 1.78 times as likely to fracture a hip as women of similar age who don’t have hot flashes. Interestingly, the researchers, reporting in The Journal of Clinical Endocrinology & Metabolism, found no association between hot flashes and vertebral fractures. However, they did find that the more severe the hot flashes, the lower the women’s bone density at the femoral neck and lumbar spine.

None of the women studied were using hormone therapy to treat menopause at baseline, and very few started hormone therapy during the mean follow-up of 8.2 years. The findings include statistical adjustment for baseline age, BMI, smoking, and other variables.

Carolyn Crandall, MD, the lead author of the study, told the Washington Post that the reason for the hot flash-hip fracture connection is “entirely a mystery.” But the authors wrote that “our analysis does suggest that impaired physical functioning may partially explain the [hip-fracture] association.” They also surmised that lower estradiol levels in women with hot flashes may partly explain the association between hot flashes and decreased bone density.