SSRIs double the risk for fracture?

Adults 50 years and older who use selective serotonin reuptake inhibitors (SSRIs) on a daily basis may be at twice the risk for clinical fragility fractures and at twice the risk for falls as those who don't, according to the results of a prospective cohort study of 5,008 randomly selected community-dwelling adults.

The authors of the study calculated a hazard rate for incident clinical fragility fracture of 2.1 (95% CI, 1.3–3.4) and an odds ratio for falls of 2.2 (95% CI, 1.4–3.5) in those subjects taking SSRIs daily. Daily SSRI use was also associated with lower bone mineral density (BMD) at the hip and a trend toward lower BMD at the spine. The effects were dose-dependent and largely the same at baseline as they were 5 years later.

It remains unclear whether the associations are due to a direct effect of SSRIs on bone physiology, to an increased risk of syncope when taking the agents, or to some combination of the two.