抗抑郁药的使用与10年骨折发生风险：基于人群的加拿大多中心骨质疏松症研究（CaMoS）
Antidepressant use and 10-year incident fracture risk: the population-based Canadian Multicentre Osteoporosis Study (CaMoS).
作者信息
Moura C, Bernatsky S, Abrahamowicz M, Papaioannou A, Bessette L, Adachi J, Goltzman D, Prior J, Kreiger N, Towheed T, Leslie W D, Kaiser S, Ioannidis G, Pickard L, Fraser L-A, Rahme E
机构信息
McGill University, Montreal, Canada,
出版信息
Osteoporos Int. 2014 May;25(5):1473-81. doi: 10.1007/s00198-014-2649-x. Epub 2014 Feb 25.
UNLABELLED
We used data from a large, prospective Canadian cohort to assess the association between selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) and fracture. We found an increased risk of fractures in individuals who used SSRI or SNRI, even after controlling for multiple risk factors.
INTRODUCTION
Previous studies have suggested an association between SSRIs and increasing risk of fragility fractures. However, the majority of these studies were not long-term analyses or were performed using administrative data and, thus, could not fully control for potential confounders. We sought to determine whether the use of SSRIs and SNRIs is associated with increased risk of fragility fracture, in adults aged 50 + .
METHODS
We used data from the Canadian Multicentre Osteoporosis Study (CaMos), a prospective randomly selected population-based community cohort; our analyses focused on subjects aged 50+. Time to event methodology was used to assess the association between SSRI/SNRI use, modeled time-dependently, and fragility fracture.
RESULTS
Among 6,645 subjects, 192 (2.9%) were using SSRIs or/and SNRIs at baseline. During the 10-year study period, 978 (14.7%) participants experienced at least one fragility fracture. In our main analysis, SSRI/SNRI use was associated with increased risk of fragility fracture (hazard ratio (HR), 1.88; 95% confidence intervals (CI), 1.48-2.39). After controlling for multiple risk factors, including Charlson score, previous falls, and bone mineral density hip and lumbar bone density, the adjusted HR for current SSRI/SNRI use remained elevated (HR, 1.68; 95% CI, 1.32-2.14).
CONCLUSIONS
Our results lend additional support to an association between SSRI/SNRI use and fragility fractures. Given the high prevalence of antidepressants use, and the impact of fractures on health, our findings may have a significant clinical impact.
未标注
我们使用了来自加拿大一个大型前瞻性队列的数据，以评估选择性5-羟色胺再摄取抑制剂（SSRI）和5-羟色胺及去甲肾上腺素再摄取抑制剂（SNRI）与骨折之间的关联。我们发现，即使在控制了多个风险因素之后，使用SSRI或SNRI的个体发生骨折的风险仍会增加。
引言
先前的研究表明，SSRI与脆性骨折风险增加之间存在关联。然而，这些研究大多不是长期分析，或者是使用行政数据进行的，因此无法完全控制潜在的混杂因素。我们试图确定在50岁及以上的成年人中，使用SSRI和SNRI是否与脆性骨折风险增加有关。
方法
我们使用了来自加拿大多中心骨质疏松症研究（CaMos）的数据，这是一个前瞻性随机选择的基于人群的社区队列；我们的分析集中在50岁以上的受试者。采用事件发生时间方法来评估随时间变化建模的SSRI/SNRI使用情况与脆性骨折之间的关联。
结果
在6645名受试者中，192名（2.9%）在基线时使用SSRI或/和SNRI。在10年的研究期间，978名（14.7%）参与者经历了至少一次脆性骨折。在我们的主要分析中，使用SSRI/SNRI与脆性骨折风险增加相关（风险比（HR），1.88；95%置信区间（CI），1.48 - 2.39）。在控制了多个风险因素后，包括查尔森评分、既往跌倒情况以及髋部和腰椎骨密度，当前使用SSRI/SNRI的校正HR仍然升高（HR，1.68；95%CI，1.32 - 2.14）。
结论
我们的结果进一步支持了使用SSRI/SNRI与脆性骨折之间的关联。鉴于抗抑郁药的高使用率以及骨折对健康的影响，我们的发现可能具有重大的临床意义。
Zotero 插件