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Current use of SSRIs and tricyclic antidepressants may increase the risk of non-vertebral fractures in the elderly

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Do selective serotonin reuptake inhibitors (SSRIs), tricyclic depressants (TCAs) and other antidepressants increase the risk of non-vertebral fractures in the elderly?


7983 people aged ⩾55 years participating in the Rotterdam study (mean age 77.5 years, 39% male). Exclusions: lived in study area <1 year and <5 months of pharmacy data available at baseline. Participants were followed-up until diagnosis of fracture, death or end of study (2002).


General population, Ommoord, Rotterdam, The Netherlands; recruitment 1990–1993.

Risk factors:

Antidepressant use, as identified from pharmacy dispensing records. Antidepressants were classified as SSRIs (fluoxetine, citalopram, paroxetine, sertraline, fluvoxamine and escitalopram), TCAs (imipramine, clomipramine, opipramol, amitriptyline, nortriptyline, doxepine, dosulepine and maprotiline) or other antidepressants (tranylcypromine, moclobemide, mianserin, trazodone, nefazodone, mirtazapine and venlafaxine). Current antidepressant use was defined as use at time of fracture; past use was defined as history of use during the study but not at the time of the fracture.


First non-vertebral fracture (reported by the participants’ general practitioner and reviewed by a medical specialist).



Prospective cohort study.

Follow-up period:

Mean follow-up 8.4 …

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  • Source of funding: Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands.


  • Competing interests: None.

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