For Menopausal Women, Rx May Up Fracture Risk

Selective serotonin reuptake inhibitors to treat menopause symptoms may raise bone fracture risk

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Women going through menopause may take antidepressants to help treat mood swings and hot flashes. These medications, however, may up women's risk of injury.

A new study found that selective serotonin reuptake inhibitors (SSRIs) may increase the risk of bone fracture among middle-aged women going through menopause. Because this raised risk appears to last for several years, the authors of this study said a shorter course of SSRI treatment may be needed.

Commonly prescribed to treat moderate to severe depression, SSRIs work primarily by affecting serotonin. Serotonin is a neurotransmitter (chemical messenger) in the brain. Some women have found that these antidepressants may reduce irritability, depression, moodiness and hot flashes that may result from menopause.

Past research has also suggested that SSRIs may affect bone density.

Matthew Miller, MD, with the Department of Health Science at Northeastern University in Boston, and colleagues conducted this study.

“We find that SSRIs are associated with higher risks of fractures, an effect that first became evident several months after treatment initiation,” Dr. Miller and team wrote. “Our finding suggests that, if feasible, shorter duration of treatment might mitigate the risk of developing excess fractures.”

They added that “Future efforts should examine whether this association pertains at lower doses.”

Dr. Miller and team reviewed data on just over 137,000 women who started treatment with SSRIs between 1998 and 2010. These women were aged 40 to 64. They had no diagnosed mental health issues, indicating that they may have been taking the antidepressants to curb menopause symptoms.

These patients were compared with more than 236,000 women of the same age who were taking H2 antagonists (also called HR blockers) or proton pump inhibitors (PPIs). These drugs are often used to treat indigestion by reducing stomach acids.

H2 antagonists and PPIs were selected for comparison because studies have shown that H2 antagonists have “trivial or no association with risk of fracture, while PPIs are associated with a slightly increased risk of fractures,” according to Dr. Miller and team.

The fracture rate was 76 percent higher among those prescribed SSRIs one year after starting treatment than it was among women taking HS antagonists or PPIs. After two years, the fracture rate was still 73 percent higher in the SSRI group. After five years, the fracture rate remained 67 percent higher compared to those being treated with the indigestion drugs.

SSRIs may lead to bone thinning rather than bone strengthening, Dr. Miller and team said.

The use of SSRIs to treat menopausal symptoms may soon increase because the US Food and Drug Administration (FDA) recently approved the SSRI paroxetine hydrochloride (brand name Paxil) for the treatment of hot flashes, night sweats and other menopausal symptoms, Dr. Miller and team noted.

SSRIs are among the most frequently prescribed classes of drugs in the US. They have been used as an effective alternative to hormone replacement therapy (HRT) in treating menopause symptoms.

The SSRIs women in this study took included citalopram hydrobromide (brand name Celexa), escitalopram oxalate (brand name Lexapro), fluoxetine hydrochloride (brand name Prozac), fluvoxamine maleate (brand name Luvox), sertraline hydrochloride (brand name Zoloft) and paroxetine hydrochloride.

“Future efforts should be made to examine how SSRI dose might modify fracture risk over time,” Dr. Miller and team wrote.

This study was published June 25 in the journal Injury Prevention.

The National Institute of Mental Health, National Institute on Aging, and Agency for Healthcare Research and Quality funded this research. One author received salary support from the Center for Pharmacoepidemiology and from unrestricted research grants from pharmaceutical companies (GlaxoSmithKline, Merck and Sanofi).

Review Date: 
June 25, 2015
Last Updated:
June 29, 2015