Canadian Study: SSRI Increase Bone Fracture Risk

As more scientists examine the side effects of selective serotonin reuptake
inhibitors (SSRIs)–the antidepressants once marketed as "wonder drugs"–the
bleaker the picture gets. Rather than "washing away" the blues–as Prozac
ads claimed–these drugs are proving to be hazardous to both physical and
mental health.

The first myth is that SSRIs–in contrast to the old tricyclic
antidepressants–are "selective" in targeting an exact neuroreceptor. In
fact, these drugs are not selective at all. SSRIs interfere with normal
physiological functions causing varying degrees of damage. The latest report
by a team of Canadian osteoporosis specialists, published in the current
issue of the Archives of Internal Medicine, found that SSRI antidepressants
reduce bone density:

"Daily use of SSRIs was also associated with a four per cent reduction in
bone mineral density of the hip and 2.4 per cent of the lower spine, the
study found. The risk of falling was also higher among those taking the
pills, which can cause a drop in blood pressure and fainting in some
people."

The senior investigator, Dr. David Golzman noted that  prescriptions for the
antidepressants soared by more than 30 per cent between 2000 and 2004. [1]
"And that puts a lot of people at increased risk for fractures over and
above the risk that they already have as a result of the fact that they're
aging and are taking other medication which may also predispose to
osteoporosis."

If one adds up ALL the risk factors associated with these drugs and weighs
those risks against the uncertain (undemonstrated) clinical benefit–as
confirmed by the government funded STAR*D study–whose drop out rate is
evidence of colossal treatment failure–[2]  the risks far outweigh the
claimed benefits. [3]

It is always astounding to read that a healthcare professional–Dr. Robert
P. Heaney (below)–expresses fear that information about drug hazards might
lead consumers to decline to take a prescribed drug. Isn't such information
the very basis for claiming that one is practicing "evidence-based medicine?"

Physicians and consumers must be fully informed about the side effects of prescribed drugs. Lacking knowledge about adverse drug effects they cannot make an informed judgment.

References:

  1. See: J. Brent Richards, MD; Alexandra Papaioannou, MD, MSc; Jonathan D.
    Adachi, MD; Lawrence Joseph, PhD; Heather E. Whitson, MD; Jerilynn C. Prior,
    MD; David Goltzman, MD; for the Canadian Multicentre Osteoporosis Study
    (CaMos) Research Group  Effect of Selective Serotonin Reuptake Inhibitors on
    the Risk of Fracture. Arch Intern Med. 2007;167:188-194. 

  2. The Wall Street Journal reported that  of the 4,041 depressed patients
    that had been enrolled in STAR*D, a government sponsored study, "only 123
    patients remained by the fourth phase." See: AVERY JOHNSON.  Study Looks at
    Resistance To Depression Treatment, THE WALL STREET JOURNAL, November 1,
    2006; Page D9 http://online.wsj.com/article/SB116234875653509763.html.  

See also: Separating Facts from Propaganda:
http://www.ahrp.org/cms/content/view/374/28/

  1. See also:  NIMH director, Dr. Thomas Insel, acknowledged in his
    accompanying editorial about STAR*D Phase I results:
            a. SSRIs don't work for 70% of patients. Only 30% of the healthiest,
    highly educated, currently employed, Caucasian women met the criteria for
    remission.
            b. "The gulf between research and practice [ ] has led to the
    unfortunate current state where too many research studies have little
    immediate relevance to practice, and too little practice is based on
    research evidence."  See: http://www.ahrp.org/cms/content/view/13/28/

Contact: Vera Hassner Sharav
212-595-8974
veracare@ahrp.org
 
~~~~~~~~~~~
HealthDay Reporter
Antidepressants Linked to Fracture Risk
Patients should have bone tests before taking SSRIs, study suggests.
By Steven Reinberg

MONDAY, Jan. 22 (HealthDay News) — Men and women in their 50s and older who
take antidepressants known as selective serotonin reuptake inhibitors may be
doubling their risk of fractures, a new Canadian study suggests.

SSRIs, such as Prozac and Paxil, are commonly used to treat depression and
anxiety. But previous studies had shown these drugs are associated with an
increased risk of fractures from falling.

The new research, led by Dr. David Goltzman, a professor of medicine and
physiology and director of the McGill Centre for Bone and Periodontal
Research at McGill University in Montreal, seems to support the earlier
studies. "There is good scientific evidence that serotonin is involved in bone
physiology, and if you alter the system, you can get low bone density,"
Goltzman said. "Patients should be monitored to prevent the risk of
fractures."

The finding is published in the Jan. 22 issue of the Archives of Internal Medicine.
For the study, Goltzman and his colleagues reviewed information on 137
patients — average age 65 — who took SSRIs. The patients had their bone
mineral density measured at the start of the study and were followed for
five years. Each year, the patients were also asked to report any fractures
they had and how they occurred.

Goltzman's team found these patients had twice the risk of fractures. They
were particularly vulnerable to breaks of the forearm, ankle and foot, and
less so to fractures of the hip, rib, femur, and back, the study found.

Goltzman's group also found that use of SSRIs was associated with an
increased risk of falling. The effect depended on the dose of the drug.
Doubling the dose resulted in a 1.5-fold increase in the risk of falling.

Daily SSRI use was also associated with a 4 percent decrease in bone mineral
density at the hip, and a 2.4 percent decrease at the spine, the researchers
reported.

Patients need to know there's this risk of fractures with SSRIs, Goltzman said.
"Patients should not be told not to take SSRIs if they need them for
depression," he said. "But this is a new risk that has been identified, and
patients should take general steps to prevent osteoporosis. And they should
have a bone density measurement before starting SSRIs and periodically after
that."

But one expert said he thought the study failed to prove that SSRI use is
linked to an increased risk of bone breaks.
"These findings are hard to interpret," said Dr. Robert P. Heaney, a
professor of medicine at the Osteoporosis Research Center at Creighton
University in Omaha, Neb. "Increased fracture risk has been associated with
depression for years," he added.

Heaney said that to really uncover the role SSRIs may play in fractures, a
study would have to compare depressed patients taking SSRIs with depressed
patients taking other medications. "Then you could see if it was the
depression causing the fractures or if it were the SSRIs. It may not be the
SSRI at all," he said.

Studies like Goltzman's run the risk that people will stop taking their
medication, Heaney said. "These kind of studies do some potential harm," he
said.

More information
The U.S. National Institute of Mental Health can tell you more about
depression <http://www.nimh.nih.gov/publicat/depression.cfm> .

(SOURCES: David Goltzman, M.D., professor of medicine and physiology,
director of the McGill Centre for Bone and Periodontal Research, McGill
University, Montreal, Canada; Robert P. Heaney, M.D., professor, medicine,
Osteoporosis Research Center, Creighton University, Omaha, Neb.; Jan. 22,
2007, Archives of Internal Medicine)

Copyright C 2007 ScoutNews, LLC <http://www.healthday.com/> . All rights
reserved.

HealthDayNews articles are derived from various sources and do not reflect
federal policy. healthfinderR does not endorse opinions, products, or
services that may appear in news stories. For more information on health
topics in the news, visit the healthfinderR health library
<http://healthfinder.gov/library/> .

http://www.thestar.com/printArticle/173686
TORONTO STAR
News – Antidepressants boost fracture risk: Study
January 22, 2007 Canadian Press

Adults aged 50 and older who take daily doses of such antidepressants as
Prozac and Paxil have double the risk of fractures from falls – and it
appears that decreased bone mass may be at least part of the reason, a
Canadian study suggests.

Participants in the McGill University study who had been taking one of five
antidepressants from the drug class known as selective serotonin reuptake
inhibitors, or SSRIs, had twice the risk of forearm, ankle, hip and other
fractures compared with those not prescribed the drugs.

Daily use of SSRIs was also associated with a four per cent reduction in
bone mineral density of the hip and 2.4 per cent of the lower spine, the
study found. The risk of falling was also higher among those taking the
pills, which can cause a drop in blood pressure and fainting in some people.

"Depression is common in the elderly, and the elderly population is
increasing in Canada and most of the Western world," said Dr. David
Goltzman, a Montreal endocrinologist and senior author of the study,
published Tuesday in the Archives of Internal Medicine.
"So depression is increasing as the population ages and the use of SSRIs is
increasing at a phenomenal rate," Goltzman said, noting that prescriptions
for the medications soared by more than 30 per cent between 2000 and 2004.

"And that puts a lot of people at increased risk for fractures over and
above the risk that they already have as a result of the fact that they're
aging and are taking other medication which may also predispose to
osteoporosis."

But Goltzman stressed the findings do not mean that people should stop
taking the antidepressants.
"I think that if they need an SSRI, if their physician feels that they need
it to treat their depression . . . they need to be treated with the
appropriate medication," he said. "It just means individuals should be aware
this is a side-effect and they should probably also take general steps in
order to prevent osteoporosis."

Those steps include engaging in weight-bearing exercise, eating a diet rich
in calcium and vitamin D, and avoiding smoking and alcohol.
Goltzman also suggests that older patients should have their bone density
tested when they begin taking an SSRI and again after they have been on the
drug for a period of time to see if their bones are thinning.

Dr. David Healy, an expert in psychopharmacology at the University of Wales
College of Medicine, said researchers are finding more and more side-effects
associated with SSRIs, which he believes are over-prescribed worldwide.

Doctors need to fully explain these side-effects before prescribing the
drugs so patients can make an informed choice about taking them, Healy said
Monday from Cardiff.

The study was funded by the Canadian Institutes of Health Research, several
drug companies including Eli Lilly Canada and Merck Frosst Canada, the Dairy
Farmers of Canada and the Arthritis Society.

FAIR USE NOTICE: This may contain copyrighted (C ) material the use of which
has not always been specifically authorized by the copyright owner. Such
material is made available for educational purposes, to advance
understanding of human rights, democracy, scientific, moral, ethical, and
social justice issues, etc. It is believed that this constitutes a 'fair
use' of any such copyrighted material as provided for in Title 17 U.S.C.
section 107 of the US Copyright Law. This material is distributed without
profit.