摘要
背景：骨折會造成病人失能、死亡並增加醫療資源的花費，西方國家進行的藥物流行病學研究發現，使用抗憂鬱劑可能會增加骨折的風險。然而，目前尚未有以亞洲人為研究對象探討抗憂鬱劑與骨折的相關性的藥物流行病學研究。 目的：欲探討臺灣居民抗憂鬱劑使用情形與骨折風險之相關性。 材料與方法：本研究使用臺灣全民健康保險研究資料庫進行病例對照研究。病例組納入1998至2005年，50歲以上初診斷為骨折（包含：脊椎、橈骨、髖骨）的病人，共10,499人。對照組為研究期間沒有發生骨折者，依年齡、性別、骨折年月、就醫類型（住院或急診）進行一比一的隨機抽樣配對。將研究對象依最後一次處方抗憂鬱劑之日期至骨折日期之間隔分為：目前使用者為骨折前30天內處方者、最近曾使用者為前31至90天內處方者，過去曾使用者為91至180天內處方者三組，評估骨折前半年內抗憂鬱劑使用情形，並以每日定義劑量（Defined Daily Dose, DDD）計算累積劑量及平均日劑量，以條件式邏輯斯回歸分析使用抗憂鬱劑與骨折的相關性。 研究結果：使用TCAs者發生骨折的勝算比為1.45（adjusted odds ratio, AOR；95% CI 1.25-1.67）；使用SSRIs者為 1.45（95% CI 1.16-1.82）；使用其他抗憂鬱劑者為 1.38（95% CI 1.15-1.65）。目前使用TCAs、SSRIs、其他抗憂鬱劑者骨折的風險皆高於過去曾使用者。此外，TCAs在低累積劑量即觀察到骨折風險增加（AOR 1.40，95% CI 1.19-1.64）。SSRIs的累積劑量超過90 DDD或平均日劑量超過1 DDD也顯著增加骨折風險，分別為2.65（95% CI 1.74-4.05）及1.71（95% CI 1.27-2.30）。骨折的風險隨著TCAs和SSRIs的累積劑量而增加，但其他抗憂鬱劑的骨折風險則未隨累積劑量而增加。 結論：使用SSRIs、TCAs或其他抗憂鬱劑相較於未使用者，有顯著的骨折風險，骨折的風險和使用高劑量的抗憂鬱劑有相關性。
並列摘要
Background: Fractures may lead to disability, deaths and increase medical costs. Several epidemiological studies done in Western populations have reported an increased risk of fracture with antidepressants use. The association between the use of antidepressants and fracture risk has not been investigated in Asian populations. Objective: To investigate the association between antidepressant treatment and the risk of fracture in Taiwan. Material and methods: A case-control study was conducted using the Taiwan’s National Health Insurance (NHI) claim database. Cases (N=10,499) were aged 50 and older who were identified with fractures (vertebral, wrist, or hip) for the first time between January 1998 and December 2005. For each case, one control without any fracture was matched by age, gender, index date (index year and month) and type of care services (inpatient or emergency services). Exposure to antidepressants was determined by reviewing prescription information before the index date (case fracture). A current user was one whose most recent drug prescription was dispensed within 30 days of the index date. A recent user was one whose most recent drug prescription was dispensed between 31 and 90 days before the index date. A past user was one whose most recent prescription was dispensed between 91 and 180 days before the index date. We reviewed antidepressants prescriptions for the 180 days before the index date. The effects of dose were examined as cumulative defined daily doses (cDDD) and defined daily dose per day (DDD/day). We used conditional logistic regressions to examine the relationship between antidepressant use and risk of fracture. Results: The risk of fractures was increased in patients treated with TCAs [adjusted odds ratio (AOR): 1.45; 95% confidence interval (95%CI): 1.25-1.67], SSRIs (AOR: 1.45; 95%CI: 1.16-1.82) and other antidepressants (AOR: 1.38; 95%CI: 1.15-1.65). For all types of antidepressants, current use was associated with a higher fracture risk than past use. An increased risk of fractures was seen at low cumulative doses of TCAs (AOR: 1.40; 95% CI 1.19-1.64). Significantly increased risks of fractures were seen in the dosage of SSRIs ≧90 cDDDs (AOR: 2.65, 95% CI 1.74-4.05) and ≧1 DDD/day (AOR: 1.71; 95% CI 1.27-2.30). There was a dose-response relationship for SSRIs and TCAs with an increase in risk of fractures with increased use in terms of cDDD, while no such relationship was seen for other antidepressants. Conclusion: The risk of fractures was increased for antidepressants users. The use of high-dose antidepressants may be associated with an increased fracture risk.