Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
JAMA Psychiatry. 2019 Feb 1;76(2):172-179. doi: 10.1001/jamapsychiatry.2018.3679.
Treatment with antidepressants has been associated with hip fracture. This association could restrict the treatment options, especially in older patients.
To investigate the association between antidepressant drug treatment and hip fracture starting 1 year before the initiation of treatment.
DESIGN, SETTING, AND PARTICIPANTS: In this nationwide cohort study, 204 072 individuals in the Prescribed Drugs Register of Sweden's National Board of Health and Welfare aged 65 years or older who had a prescription of antidepressants filled between July 1, 2006, and December 31, 2011, were matched by birth year and sex to 1 control participant who was not prescribed antidepressants (for a total of 408 144 people in the register). Outcome data were collected from 1 year before to 1 year after the index date (date of prescription being filled). Data analysis was performed from July 1, 2005, to December 31, 2012.
First filled prescription of an antidepressant drug.
Incident hip fractures occurring in the year before and year after initiation of antidepressant therapy were registered. Associations were investigated using multivariable conditional logistic regression models and flexible parametric models.
Of the 408 144 people in the register who were included in the study, 257 486 (63.1%) were women, with a mean (SD) age of 80.1 (7.2) years. Antidepressant users sustained more than twice as many hip fractures than did nonusers in the year before and year after the initiation of therapy (2.8% vs 1.1% and 3.5% vs 1.3%, respectively, per actual incidence figures). In adjusted analyses, the odds ratios were highest for the associations between antidepressant use and hip fracture 16 to 30 days before the prescription was filled (odds ratio, 5.76; 95% CI, 4.73-7.01). In all separate analyses of age groups, of men and women, and of individual antidepressants, the highest odds ratios were seen 16 to 30 days before initiation of treatment, and no clear dose-response relationship was seen.
The present study found an association between antidepressant drug use and hip fracture before and after the initiation of therapy. This finding raises questions about the association that should be further investigated in treatment studies.
抗抑郁药物治疗与髋部骨折有关。这种关联可能会限制治疗选择，尤其是在老年患者中。
调查抗抑郁药物治疗开始前 1 年开始治疗后，与髋部骨折之间的关联。
设计、地点和参与者：在这项全国性队列研究中，瑞典国家卫生和福利委员会处方药物登记处的 204072 名年龄在 65 岁或以上的患者在 2006 年 7 月 1 日至 2011 年 12 月 31 日期间接受了抗抑郁药物处方，与未开抗抑郁药物的 1 名对照参与者（登记处共有 408144 人）按出生年份和性别进行匹配。从索引日期（处方填写日期）前 1 年到后 1 年收集结果数据。数据分析于 2005 年 7 月 1 日至 2012 年 12 月 31 日进行。
首次开出抗抑郁药物处方。
在抗抑郁治疗开始前和开始后一年发生的髋部骨折。使用多变量条件逻辑回归模型和灵活参数模型调查关联。
在登记处的 408144 名患者中，有 257486 名（63.1%）为女性，平均（SD）年龄为 80.1（7.2）岁。与未使用者相比，抗抑郁药使用者在治疗开始前和治疗开始后一年发生髋部骨折的人数超过两倍（实际发病率分别为 2.8%和 1.1%，3.5%和 1.3%）。在调整后的分析中，与抗抑郁药使用和髋部骨折相关的比值比最高，发生在处方开具前 16 至 30 天（比值比，5.76；95%置信区间，4.73-7.01）。在所有年龄组、男性和女性以及单独的抗抑郁药的单独分析中，在治疗开始前 16 至 30 天观察到的比值比最高，并且没有观察到明确的剂量反应关系。
本研究发现抗抑郁药物治疗开始前和开始后与髋部骨折之间存在关联。这一发现引发了对这种关联的质疑，需要在治疗研究中进一步调查。
