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Prozac-popping Elders at Higher Risk of Fractures

A study by Dr. David Goltzman, a professor of medicine and physiology and director of the McGill Centre for Bone and Periodontal Research at McGill University in Montreal//, and colleagues, have come out with findings that would be relevant in geriatric medicine and psychiatry.

Elderly persons aged above 50 years who take anti-depressants regularly run a risk of increased fractures.

The study published in the Archives of Internal Medicine seems to support previous studies that were concerned with this area.

Anti-depressants commonly used include Prozac and Paxil. These are called selective serotonin reuptake inhibitors or SSRIs.

Around one in every ten elderly American suffers from depression and SSRIs are the normal means of treatment.

Says Goltzman,"There is good scientific evidence that serotonin is involved in bone physiology, and if you alter the system, you can get low bone density. Patients should be monitored to prevent the risk of fractures."

The study was based on a five-year study and follow -up on 137 patients aged around 65 years.

They were quizzed regularly on their dosage of SSRIs, bone density levels and the incidence of fractures.

Results showed that daily SSRIs use was associated with a 4 percent decrease in bone mineral density at the hip, and a 2.4 percent decrease at the spine. There was also an increased risk of falling.

Doubling the dose of SSRIs was found to increase falling by 1.5 times.

The areas prone to fracture were those where low impact stress occurred like the forearm, ankle and foot.

There are those who refute the findings like Dr. Robert P. Heaney, a professor of medicine at the Osteoporosis Research Center at Creighton University in Omaha, Neb.

Heaney says that to really uncover the role SSRIs may play in fractures, a study would have to compare depressed patients taking SSRIs with depressed patients taking other medications. "Then you could see if it was the depression causing the fractures or if it were the SSRIs. It may not be the SSRI at all," he says.

Concludes Goltzman who opines that physicians should balance the benefits of treating depression with the increased risk of fractures, "Patients should not be told not to take SSRIs if they need them for depression, but this is a new risk that has been identified, and patients should take general steps to prevent osteoporosis. And they should have a bone density measurement before starting SSRIs and periodically after that."

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