Depression Drugs Raise Risk of Fractures and Falls

Healthnotes Newswire (March 8, 2007)—Adults ages 50 and older who use Prozac and other drugs in its class have double the risk of falls and fractures, according to a new study.

Selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants, are often used to treat depression in seniors. They include citalopram (Celexa), escitalopram oxalate (Lexapro), fluoxetine (Prozac), fluvoxamine maleate (Luvox), paroxetine (Paxil), sertraline (Zoloft), and dapoxetine.

“Recent research reveals a potentially important role for serotonin in bone physiology,” said David Goltzman, MD, of the Bone and Calcium Research Laboratories at Royal Victoria Hospital in Montreal, Quebec, and the study’s senior author. “Given the high prevalence of SSRI use and the frequent occurrence of fragility fractures in the elderly population, we thought it was important to determine if daily SSRI use increases the risk of fracture.”

With age, skeletons become more fragile and that increases the risk of breaking a bone if we fall down. Falls account for 90% of hip fractures. Approximately one-third of people 65 or over fall at least once a year. Whether or not a fracture occurs depends on bone strength and the impact from the fall. Bone strength is directly related to mineral content, with fracture risk increasing as bone mineral density decreases.

The new study monitored 5,008 community-dwelling adults 50 years and older, 137 (2.7%) of whom used SSRIs daily and 609 (12.2%) of whom reported depression symptoms. Daily SSRI use was associated with a two-fold increased risk of fragility fractures. Higher doses of SSRIs were associated with higher risk of fractures. Daily SSRI use was also associated with a doubled risk of falling, lower bone mineral density at the hip, and a trend toward lower bone mineral density at the spine.

Depression affects approximately 10% of people making doctor visits each year in the United States. SSRIs are the choice for many doctors for treating depression among older adults because these drugs are usually thought of as having only mild adverse effects. The use of SSRIs is widespread and growing. Combined sales of the drugs in the United States was more than $10.9 billion in 2004.

“Elderly persons are at increased risk of developing osteoporosis and depression,” Dr. Goltzman said. “Daily SSRI use in this population to treat depression may increase the risk of subsequent fracture. These risks must be balanced against the benefits gained by the treatment of depression with SSRIs.”

People suffering from depression, whether or not they are taking SSRIs, could benefit from exercise that raises the heart rate at least three hours a week (or 30 minutes a day). For those not taking SSRIs, taking a supplement containing folic acid and vitamins B12 and B6 may help correct some deficiencies associated with depression. St. John’s wort (Hypericum perforatum) extracts (600 to 1,200 mg a day of a standardized herbal extract containing of 0.3% hypericin) may also help with mild to moderate depression—but talk to your doctor first as St. John’s wort can interact with certain medications.

While it is not known if nutritional supplementation can specifically offset the increased fracture risk posed by SSRI use, it is prudent for seniors, even if they are not taking SSRIs, to take steps to prevent loss of bone mineral density:

• Get enough calcium (800 to 1,000 mg of supplemental calcium in addition to 500 to 700 mg from the diet).

• Get enough vitamin D (moderate sunlight exposure and 400 IU per day of a supplement).

• Avoid excessive salt and caffeine consumption.

• Make weight-bearing exercise a regular habit.

(Arch Intern Med 2007;167:188–94)

Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.

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