Abstract: SA-PO661
Selective Serotonin Reuptake Inhibitors Associate with Hip Fracture Risk Among Patients on Hemodialysis
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Vangala, Chandan, Baylor College of Medicine, Houston, Texas, United States
- Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
Background
Selective serotonin reuptake inhibitor (SSRI) use has been associated with hip fracture risk in the general population. Patients with end-stage renal disease on hemodialysis (HD) are a unique, high-risk subset with distinct metabolism and bone pathology, and the impact of SSRI use on hip fracture risk in this subset remains unexplored.
Methods
Using the U.S. Renal Data System, we identified all hip fracture events recorded between 2006 and 2014 among HD-dependent patients. Eligible cases were matched on index date with 10 controls; all were required to have >1 year of Medicare Parts A & B coverage. To study cumulative long-term exposure, we further required >3 years of part D coverage. We defined and stratified SSRI use by the proportion of days covered by filled prescriptions in the 3 years prior to index. In a separate study of short-term exposure, we selected subjects with >18 months of Part D coverage and required no prior antidepressant use for 1 year (months 7-18). We defined SSRI use by filled claims in the 6 months prior to index. Using conditional logistic regression, we estimated unadjusted and multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results
In the long-term study, we identified 4,551 cases and 45,510 controls. Compared to controls, a larger proportion of cases had any prior SSRI (37.2% vs. 27.6%) use. Use of SSRIs was associated with increased hip fracture risk (adjusted OR 1.30, 95% CI 1.20-1.40). The subgroups of low, moderate, and high SSRI use yielded adjusted ORs of 1.27 (1.15-1.41), 1.32 (1.19-1.45), and 1.31 (1.16-1.47), respectively. In the short-term study, we examined 4,354 cases and 43,540 controls. Increased hip fracture risk was also associated with short-term use of SSRIs (adjusted OR 1.51, 95% CI 1.29-1.76).
Conclusion
Compared to long-term SSRI use, the stronger association of short-term use with increased hip fracture risk in HD-dependent patients may suggest an acute mechanism potentially related to falls.
Funding
- Private Foundation Support