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Am Fam Physician. 1998;58(2):516-518

The risk of falls and hip fractures in the elderly has been shown to increase with the use of psychotropic medications. This may be attributed to side effects of traditional antidepressant medications, such as sedation, orthostatic hypotension, confusion and cardiac irregularities. The selective serotonin reuptake inhibitors (SSRIs), which have rapidly replaced more traditional antidepressant medications for use in elderly patients, may have fewer hazardous side effects. Liu and colleagues studied the risk of hip fracture associated with the use of SSRIs compared with the risk of hip fracture associated with the use of traditional antidepressants in elderly patients.

Elderly Canadian patients hospitalized for treatment of hip fracture between April 1, 1994, and March 31, 1995, were included in the study. Patients who resided in long-term care facilities or had epilepsy, trauma or pathologic fracture were excluded from participation. Each case was matched by age and sex with five control subjects. Information about drugs prescribed for both study and control subjects was obtained from the drug benefit program, which serves all elderly Canadian residents.

Of the 8,239 study subjects, 6.6 percent had received a prescription for SSRIs, compared with 2.8 percent of the control subjects. A total of 11.6 percent of the study subjects and 7.7 percent of the control subjects were taking tricyclic antidepressants. The adjusted odds ratio for hip fracture was 2.4 for the patients taking SSRIs, compared with 1.5 to 2.2 for the patients taking traditional antidepressants. Risk was higher in new users of all antidepressant drugs. Patients taking antidepressants were more likely to take other drugs and to have undergone previous hospital admission for dementia.

The authors conclude that the use of any antidepressant medication in elderly patients increases the risk of hip fracture. SSRIs do not appear to offer an advantage over the traditional antidepressants. Treatment of depression in the elderly can have great benefit, but it must be balanced against the increased risk of hip fracture, which carries high rates of mortality and morbidity in elderly patients.

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Copyright © 1998 by the American Academy of Family Physicians.

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