Research Department of Practice and Policy, UCL School of Pharmacy, BMA House, Tavistock Square, London, WC1H 9JP, UK.
Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Arch Osteoporos. 2024 Oct 23;19(1):100. doi: 10.1007/s11657-024-01459-3.
In a population-based cohort study of menopausal women with common mental health diagnoses, SSRIs/SNRIs were associated with a 32% increased risk of osteoporotic fractures. The risk of osteoporotic fractures was particularly increased for longer periods of treatment with SSRIs/SNRIs (> 5 years) and in younger menopausal women (< 50 years old).
To investigate the association between selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and the risk of osteoporotic fractures (OF) in menopausal women with common mental health diagnoses (CMHD).
We conducted the study with two designs (cohort and self-controlled case series [SCCS]), using the IQVIA Medical Research Database (IMRD) UK. The source population comprised women aged ≥ 50 years and women with a record indicating menopause (< 50 years). All women had a recorded CMHD. For the cohort analysis, the risk of OFs was estimated by comparing women prescribed SSRIs/SNRIs (exposed) to those not exposed. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CIs). For the SCCS, women acted as their own controls; periods of exposure to SSRIs/SNRIs were compared to periods of non-exposure using conditional Poisson regression to estimate incidence rate ratios (IRR) with 95% CIs.
We identified 292,848 women, of whom 35,222 experienced OFs within a median follow-up of 6.01 years. We found strong evidence of an association between SSRIs/SNRIs and the risk of OFs (adjusted HR = 1.32, 95% CI:1.29-1.35). Compared to periods of no exposure, SSRIs/SNRIs increased the risk of OFs during the first 30 days (IRR = 1.38, 95% CI:1.26-1.51), during the first 90 days (IRR = 1.58, 95% CI: 1.48-1.69), and the remaining exposure (IRR = 1.42, 95% CI:1.37-1.48).
In a population of menopausal women with CMHDs, the prescribing of SSRIs/SNRIs antidepressants was associated with a higher risk of OFs. Careful assessment of osteoporosis risk needs to be considered when treating menopausal women with SSRIs/SNRIs antidepressants.
调查选择性 5-羟色胺再摄取抑制剂（SSRIs）和 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）与有常见精神健康诊断（CMHD）的绝经后妇女骨质疏松性骨折（OF）风险之间的关联。
我们使用 IQVIA 医疗研究数据库（IMRD）英国进行了两项设计（队列和自我对照病例系列[SCCS]）的研究。源人群包括年龄≥50 岁的女性和有记录表明绝经（<50 岁）的女性。所有女性均有记录的 CMHD。对于队列分析，通过比较服用 SSRIs/SNRIs（暴露）的女性与未暴露的女性，估计 OF 的风险。Cox 回归用于估计 95%置信区间（CI）的危险比（HR）。对于 SCCS，女性作为自己的对照；使用条件泊松回归比较 SSRIs/SNRIs 暴露期与非暴露期，以估计 95%CI 的发病率比（IRR）。
我们确定了 292848 名女性，其中 35222 名女性在中位随访 6.01 年内发生 OF。我们发现 SSRIs/SNRIs 与 OF 风险之间存在很强的关联（调整后的 HR=1.32，95%CI：1.29-1.35）。与无暴露期相比，SSRIs/SNRIs 增加了前 30 天（IRR=1.38，95%CI：1.26-1.51）、前 90 天（IRR=1.58，95%CI：1.48-1.69）和剩余暴露期（IRR=1.42，95%CI：1.37-1.48）的 OF 风险。
在有 CMHD 的绝经后妇女人群中，SSRIs/SNRIs 抗抑郁药的处方与 OF 风险增加相关。在使用 SSRIs/SNRIs 抗抑郁药治疗绝经后妇女时，需要仔细评估骨质疏松症风险。
