Alliance between selective serotonin reuptake inhibitors and fracture risk: an updated systematic review and meta-analys
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PHARMACODYNAMICS
Alliance between selective serotonin reuptake inhibitors and fracture risk: an updated systematic review and meta-analysis Manoj Kumar 1 & Ram Bajpai 2 & Abdul Rahaman Shaik 3 & Swati Srivastava 4 & Divya Vohora 1,3 Received: 23 July 2019 / Accepted: 8 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose In the past few years, several fracture-related events have been reported with chronic use of selective serotonin reuptake inhibitors (SSRIs) throughout the globe. Hence, an updated systematic review and meta-analysis was necessary to ascertain the risk involved. The present work evaluated the association of SSRIs with the risk of fracture in adults. Methods We systematically searched PubMed, Cochrane library, and Google Scholar for observational studies on the same from inception to April 2019. Screening, data extraction, and risk of bias assessment were conducted independently by 2 authors. Results We assessed 69 studies out of which 37 (14 case-control, 23 cohorts) were included. Our results showed that SSRIs were significantly associated with an increased fracture risk (relative risk of 1.62, 95% CI 1.52–1.73; P < 0.000; I2 = 90.8%). The relative risk values for case-control and cohort studies were found to be 1.80 (95% CI 1.58–2.03; P < 0.000; I2 = 93.2%) and 1.51 (95% CI 1.39–1.64; P < 0.000; I2 = 88.0%) respectively. Subgroup analysis showed that association of risk of fracture persisted regardless of geographical location, study design, risk factors, defined daily dose, SSRI use duration, site of the fracture, period of study and after adjusting for depression, physical activity, gender, and age group. The sensitivity analysis data shows that the studies adjusted for bone mineral density and osteoporosis show lesser fracture risk. Conclusion Our findings suggests that SSRIs may be associated with an increased fracture risk; hence, bone health should be taken into consideration while prescribing this class of drugs. Keywords Selective serotonin reuptake inhibitors . SSRI . Fracture risk . Systematic review . Meta-analysis . Antidepressants
Introduction In a lifetime, more than 50% of women and 25% of men experience at least one fragility fracture [1]. The mortality Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-020-02893-1) contains supplementary material, which is available to authorized users. * Divya Vohora [email protected]; [email protected] 1
Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
2
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
3
Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
4
Central Drugs Standard Control Organization, Ministry of Health and Family Welfare, Directorate General of Health Services, Government of India, New Delhi 110002, India
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