Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture

• Published in: Osteoporosis international Vol. 17; no. 6; pp. 807 - 816
• Main Authors: Vestergaard, P., Rejnmark, L., Mosekilde, L.
• Format: Journal Article
• Language: English
• Published: London Springer 01.06.2006; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia; Anti-Anxiety Agents - adverse effects; Antidepressants; Antidepressive Agents - adverse effects; Antipsychotic Agents - adverse effects; Antipsychotics; Biological and medical sciences; Case-Control Studies; Child; Child, Preschool; Denmark - epidemiology; Disease; Diseases of the osteoarticular system; Dose-Response Relationship, Drug; Drug dosages; Female; Fractures; Fractures, Bone - chemically induced; Fractures, Bone - epidemiology; Hospital Records; Hospitals; Humans; Hypnotics and Sedatives - adverse effects; Infant; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Mental depression; Middle Aged; Odds Ratio; Osteoporosis; Osteoporosis. Osteomalacia. Paget disease; Prescription drugs; Reimbursement; Risk Factors; Scandals; Tranquilizers; Traumas. Diseases due to physical agents; Denmark; Aarhus Denmark; Sedatives; Osteoporosis; Neuroleptics; Antidepressants; Diseases of the osteoarticular system; Risk factor; Rheumatology; Fracture; Sedative; Trauma; Anxiolytics
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-005-0065-y

Our objective was to study the association between fracture risk and the use of anxiolytics and sedatives (benzodiazepines, etc.), neuroleptics and antidepressants. This was a case control study. All cases consisted of subjects who had sustained a fracture during the year 2000 (n=124,655). For each case, three controls (n=373,962) matched for age and gender were randomly drawn from the background population. Exposure was defined as the use of neuroleptics, antidepressants and anxiolytics/sedatives, psychiatric disease (manic depressive states, schizophrenia, other psychoses), and other confounders. The effect of dose was examined as a defined daily dose per day (DDD/day). The values referred to are confounder-adjusted. For anxiolytics and sedatives, there was a small increase in overall fracture risk (OR: around 1.1) even with limited doses (<0.1 DDD/day). No dose-response relationship was observed for anxiolytics and sedatives. For neuroleptics, a limited increase in overall fracture risk was observed (OR: around 1.2 from <0.05 DDD/day with no dose-response relationship). For antidepressants, a dose-response relationship was observed for fracture risk (OR: increasing from 1.15, 95% CI: 1.11-1.19 at <0.15 DDD/day to 1.40, 95% CI: 1.35-1.46 for >or=0.75 DDD/day). The risk of fracture was higher with selective serotonin re-uptake inhibitors than with tricyclic antidepressants. Small increases in fracture risk were seen with the use of anxiolytics and sedatives and neuroleptics without a dose-response relationship. The increase may be linked to an increased risk of falls. For antidepressants, a dose-response relationship was found, with a higher fracture risk for selective serotonin re-uptake inhibitors.