Oral Presentation 30th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2020

Antidepressant use, depressive symptoms and incident fracture: data from the PROFRAC study (#38)

Jasmine R Cleminson 1 , Lana J Williams 1 2 , Julie A Pasco 1 2 3 , Sharon L Brennan-Olsen 4 5 6 , Michael Berk 1 7 8 9
  1. School of Medicine, Deakin University, Geelong, Victoria, Australia
  2. Barwon Health, Geelong, Victoria, Australia
  3. Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, Victoria, Australia
  4. School of Health and Social Development, Deakin University, Waterfront Geelong Campus, Victoria, Australia
  5. Institute for Health Transformation, Deakin University, Waterfront Geelong Campus, Victoria, Australia
  6. Department of Medicine, Western Health, St Albans, Melbourne, Victoria, Australia
  7. The University of Melbourne, Parkville, Victoria, Australia
  8. Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
  9. Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Victoria, Australia

Background: Bone deficiencies have been identified in individuals with depression, and antidepressants use. We aimed to investigate the association between antidepressant use and incident fracture utilizing data from the Predictors and Outcomes of incident FRACtures (PROFRAC) study and Geelong Osteoporosis Study.

Method: Men and women who had sustained an incident fracture (cases, n=1458, 48.22% men) were recruited from the Barwon Statistical Division and participants of the Geelong Osteoporosis Study, with no history of adult fracture, selected as controls (n=1795, 53.54% men). Information on medication use, depressive and anxiety symptoms (HADS), falls history, previous fracture and lifestyle variables were obtained via questionnaire. Binary logistic regression models were used to test associations, after adjusting for covariates.

Results: Women: Compared to controls, fracture cases were older, had lower BMI, were less active, more likely to have depressive symptoms and take antidepressant medication, otherwise the groups were similar. Antidepressant use was associated with an increased risk of fracture compared to non-users (OR 1.41, 95% CI 1.08-1.83). Associations persisted after further adjustment for physical activity, falls, previous fracture, anxiety symptoms, and medications known to affect bone (OR 1.52, 95% CI 1.10-2.10).

Men: Fracture cases were younger, had lower BMI, more likely to smoke, be active and take antidepressant medication compared to controls, otherwise, the groups were similar. Following age-adjustment, antidepressant use was associated with an increased risk of fracture compared to non-users (OR 2.25, 95% CI 1.56-3.26). These associations persisted after further adjustment for BMI, depressive and anxiety symptoms and medications known to affect bone (OR 1.90, 95% CI 1.24-2.90).

Conclusion: These data suggest antidepressant use is associated with an increased likelihood of fracture, indicating the need for careful evaluation of risks and benefits when prescribing antidepressants. Further research to understand the underpinning mechanism is warranted.