Joensuu, Finland—For noninstitutionalized Alzheimer’s disease (AD) patients, use of antidepressants nearly doubles the risk of hip fracture, according to a new Finnish study.

The report in the International Journal of Geriatric Psychiatry notes that, while the increased risk peaked at initiation of the drugs, it remained elevated even 4 years later.

To determine that, University of Eastern Finland researchers matched by age and sex each person with AD with two controls without the disease. While antidepressant use was associated with two times higher risk of hip fracture among controls, results indicate that the relative number of hip fractures was higher among persons with AD compared to those without.

The register-based MEDALZ cohort, which includes data on all community-dwelling persons diagnosed with AD in Finland between 2005 and 2011, was used in the research. Participants, with a mean age of 80, included 50,491 individuals with and 100,982 persons without Alzheimer’s. The follow-up was 4 years from the date of AD diagnosis or a corresponding date for controls.

Analysis uncovered increased risk with all of the most frequently used antidepressant groups—selective serotonin reuptake inhibitors (SSRIs), mirtazapine, and selective noradrenaline reuptake inhibitors (SNRIs). That association persisted even after adjusting the results for osteoporosis, socioeconomic status, history of psychiatric diseases, and medications or chronic diseases increasing the risk of fall or fracture.

During antidepressant use, the age-adjusted rate of hip fractures per 100 person-years was 3.01 among persons with AD and 2.28  among persons without the neurological condition. Antidepressant use also was associated with an increased risk of hip fracture among persons with and without AD, adjusted HR 1.61, compared with nonuse.

Background information in the articles points out that antidepressants are not only used for the treatment of depression but also might be prescribed for chronic pain and behavioral and psychological symptoms of dementia, including insomnia, anxiety, and agitation.

If antidepressant use is necessary, researchers recommend that the medication and its’ necessity be monitored regularly and that other risk factors for falling should be taken into consideration.

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