June 30, 2015

The United States Food and Drug Administration (FDA) recently approved the use of selective serotonin reuptake inhibitors (SSRIs) to treat vasomotor symptoms associated with menopause. Vasomotor menopausal symptoms (VMS) include hot flashes and night sweats.

Use of low-dose SSRIs for non-psychiatric conditions has increased over the past two decades, and SSRIs are so effective at reducing VMS that they have been suggested as an alternative to hormone replacement therapy. Little is known, however, about the risks associated with SSRI use in patients without mental disorders.

Dr. Til Stürmer

Dr. Til Stürmer

A team of researchers examined the impact of SSRI use on fracture risk in women from 40 to 64 years old with no record of mental illness. Researchers from the UNC-Chapel Hill Gillings School of Global Public Health include Til Stürmer, MD, PhD, professor and director of the Center for Pharmacoepidemiology, and Virginia Pate, MS, applications analyst, both with the Department of Epidemiology.

The study, titled “SSRI use and risk of fractures among perimenopausal women without mental disorders,” was published online June 25 in Injury Prevention.

Using data from an insurance claims database, the research team compared women in the target group who used SSRIs with similar women who used H2 antagonists or proton-pump inhibitors.

Researchers found that among a population of middle-aged women without psychiatric diagnoses, patients initiating treatment with SSRIs had a higher risk of fractures over the entire five-year study period.

Results from analyses that examined lag and induction periods suggest that it takes several months of SSRI use to produce clinically meaningful cumulative effects on fracture risk. Findings from the current study are consistent with results from previous studies of fracture risk in patients with mental disorders who use SSRIs, and with the longstanding hypothesis that prolonged SSRI use lowers bone mineral density.

As the number of SSRI users without mental illness is expected to rise following the FDA’s approval of the drugs for treatment of VMS, further research is needed to explore specifically the effects of SSRI dose on fracture risk over time and the extent to which shorter duration of treatment with SSRIs may mitigate risk.

“These results are not definitive and should not lead women to stop taking SSRIs for short-term relief of perimenopausal symptoms,” Stürmer cautioned. “Our results raise some concerns, however, that will need to be further evaluated and quantified.”


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Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu
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