Antidepressants and opioids linked to higher fracture risk in rheumatoid arthritis

Opioids and selective serotonin reuptake inhibitors – a group of antidepressants – are associated with higher risk of osteoporotic fractures in people with rheumatoid arthritis, according to data presented at an international rheumatology conference in the US.

Previous research has shown that people with rheumatoid arthritis are more likely to develop osteoporosis and fractures because of chronic inflammation and glucocorticoid use.

So a team looked at the impact different medication could have on fracture risk in 11,049 people with rheumatoid arthritis to see if there were any new links. The medications they looked at were: disease-modifying antirheumatic drugs, statins, antidepressants, proton pump inhibitors, nonsteroidal anti-inflammatory drugs, anticonvulsants and antipsychotics.

Over the six-year study, people who had fractures tended to be older, have higher disease activity, longer disease duration, higher rates of glucocorticoid use, higher fracture risk and more comorbidity at the baseline.

There were also increases in fracture risk when people used SSRIs (a commonly prescribed group of antidepressants) or opioids of any strength. Risk was greater with long-term use.

It is thought that the increased fracture risk linked to use of opioids or these antidepressants may be because people taking them are more likely to fall.

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