Kumar Manoj, Bajpai Ram, Shaik Abdul Rahaman, Srivastava Swati, Vohora Divya
Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Eur J Clin Pharmacol. 2020 Oct;76(10):1373-1392. doi: 10.1007/s00228-020-02893-1. Epub 2020 Jun 16.
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.
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.
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; I = 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; I = 93.2%) and 1.51 (95% CI 1.39-1.64; P < 0.000; I = 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.
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.
在过去几年中，全球范围内有几起关于长期使用选择性5-羟色胺再摄取抑制剂（SSRI）导致的与骨折相关事件的报道。因此，有必要进行一次更新的系统评价和荟萃分析，以确定其中涉及的风险。本研究评估了SSRI与成人骨折风险之间的关联。
我们系统检索了PubMed、Cochrane图书馆和谷歌学术，以查找从开始到2019年4月关于此主题的观察性研究。由两名作者独立进行筛选、数据提取和偏倚风险评估。
我们评估了69项研究，其中37项（14项病例对照研究、23项队列研究）被纳入。我们的结果显示，SSRI与骨折风险增加显著相关（相对风险为1.62，95%置信区间1.52 - 1.73；P < 0.000；I² = 90.8%）。病例对照研究和队列研究的相对风险值分别为1.80（95%置信区间1.58 - 2.03；P < 0.000；I² = 93.2%）和1.51（95%置信区间1.39 - 1.64；P < 0.000；I² = 88.0%）。亚组分析表明，无论地理位置、研究设计、风险因素、限定日剂量、SSRI使用时长、骨折部位、研究时间段，以及在对抑郁、身体活动、性别和年龄组进行校正后，骨折风险的关联依然存在。敏感性分析数据表明，对骨密度和骨质疏松进行校正的研究显示骨折风险较低。
我们的研究结果表明，SSRI可能与骨折风险增加有关；因此，在开具此类药物处方时应考虑骨骼健康。
