study published early online just last Thursday in the British Journal of Clinical Pharmacology in which the authors followed 248 institutionalized patients with dementia for 2 years and found a statistically significant association between SSRI dose and fall risk. As expected, the addition of a sedative-hypnotic only increased the risk of falling.Serendipitiously, I stumbled upon a
Upon looking into this further, I then dug up a prospective cohort study published 5 years ago to the day in Archives of Internal Medicine in which the authors followed over 5,000 community dwelling participants over 50yo for 5yrs and found an increase risk of fractures in those who took SSRIs, everything else being equal.
Of course, we're all curious as to the possible mechanism of action so I had to look deeper in my USB flashdrive of studies and guess what? Published six months later in the same journal , authors noted decreased bone mineral density in close to 6,000 men avg 73yo who reported taking SSRIs compared to those taking other antidepressants. Given that what's good for the gander is good for the goose, in that very same issue, another study of over 2,700 women avg 78yo followed for almost 5yrs noted an increase loss of bone mineral density in those taking SSRIs compared to those taking other antidepressants. This doesn't necessarily explain the increase in fall risk but it certainly increases my concern for the potential aftermath.
So there you have it. While association does not imply causation, the evidence certainly is compelling enough for us to reconsider how we're going to treat our depressed elderly, regardless of whether they're demented or not. Any ideas?