Bone mineral density in subjects using central nervous system-active medications

Mitsuyo Kinjo, Soko Setoguchi Iwata, Sebastian Schneeweiss, Daniel H. Solomon

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

PURPOSE: Decreased bone mineral density defines osteoporosis according to the World Health Organization and is an important predictor of future fractures. The use of several types of central nervous system-active drugs, including benzodiazepines, anticonvulsants, antidepressants, and opioids, have all been associated with increased risk of fracture. However, it is unclear whether such an increase in risk is related to an effect of bone mineral density or to other factors, such as increased risk of falls. We sought to examine the relationship between bone mineral density and the use of benzodiazepines, anticonvulsants, antidepressants, and opioids in a representative US population-based sample. SUBJECTS AND METHODS: We analyzed data on adults aged 17 years and older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Total femoral bone mineral density of 7114 male and 7532 female participants was measured by dual-energy x-ray absorptiometry. Multivariable linear regression models were used to quantify the relation between central nervous system medication exposure and total femoral bone mineral density. Models controlled for relevant covariates, including age, sex, and body mass index. RESULTS: In linear regression models, significantly reduced bone mineral density was found in subjects taking anticonvulsants (0.92 g/cm2; 95% confidence interval [CI]: 0.89 to 0.94) and opioids (0.92 g/cm2; 95% CI: 0.88 to 0.95) compared with nonusers (0.95 g/cm2; 95% CI: 0.95 to 0.95) after adjusting for several potential confounders. The other central nervous system-active drugs-benzodiazepines or antidepressants-were not associated with significantly reduced bone mineral density. CONCLUSION: In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. These findings have implications for fracture-prevention strategies.

Original languageEnglish (US)
Pages (from-to)1414.e7-1414.e12
JournalAmerican Journal of Medicine
Volume118
Issue number12
DOIs
StatePublished - Jan 1 2005

Fingerprint

Bone Density
Central Nervous System
Benzodiazepines
Anticonvulsants
Opioid Analgesics
Antidepressive Agents
Nutrition Surveys
Linear Models
Central Nervous System Agents
Confidence Intervals
Thigh
Osteoporosis
Body Mass Index
Cross-Sectional Studies
X-Rays
Population

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Keywords

  • Anticonvulsants
  • Antidepressants
  • Benzodiazepines
  • Bone mineral density
  • Opioids

Cite this

Kinjo, Mitsuyo ; Setoguchi Iwata, Soko ; Schneeweiss, Sebastian ; Solomon, Daniel H. / Bone mineral density in subjects using central nervous system-active medications. In: American Journal of Medicine. 2005 ; Vol. 118, No. 12. pp. 1414.e7-1414.e12.
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abstract = "PURPOSE: Decreased bone mineral density defines osteoporosis according to the World Health Organization and is an important predictor of future fractures. The use of several types of central nervous system-active drugs, including benzodiazepines, anticonvulsants, antidepressants, and opioids, have all been associated with increased risk of fracture. However, it is unclear whether such an increase in risk is related to an effect of bone mineral density or to other factors, such as increased risk of falls. We sought to examine the relationship between bone mineral density and the use of benzodiazepines, anticonvulsants, antidepressants, and opioids in a representative US population-based sample. SUBJECTS AND METHODS: We analyzed data on adults aged 17 years and older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Total femoral bone mineral density of 7114 male and 7532 female participants was measured by dual-energy x-ray absorptiometry. Multivariable linear regression models were used to quantify the relation between central nervous system medication exposure and total femoral bone mineral density. Models controlled for relevant covariates, including age, sex, and body mass index. RESULTS: In linear regression models, significantly reduced bone mineral density was found in subjects taking anticonvulsants (0.92 g/cm2; 95{\%} confidence interval [CI]: 0.89 to 0.94) and opioids (0.92 g/cm2; 95{\%} CI: 0.88 to 0.95) compared with nonusers (0.95 g/cm2; 95{\%} CI: 0.95 to 0.95) after adjusting for several potential confounders. The other central nervous system-active drugs-benzodiazepines or antidepressants-were not associated with significantly reduced bone mineral density. CONCLUSION: In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. These findings have implications for fracture-prevention strategies.",
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Bone mineral density in subjects using central nervous system-active medications. / Kinjo, Mitsuyo; Setoguchi Iwata, Soko; Schneeweiss, Sebastian; Solomon, Daniel H.

In: American Journal of Medicine, Vol. 118, No. 12, 01.01.2005, p. 1414.e7-1414.e12.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bone mineral density in subjects using central nervous system-active medications

AU - Kinjo, Mitsuyo

AU - Setoguchi Iwata, Soko

AU - Schneeweiss, Sebastian

AU - Solomon, Daniel H.

PY - 2005/1/1

Y1 - 2005/1/1

N2 - PURPOSE: Decreased bone mineral density defines osteoporosis according to the World Health Organization and is an important predictor of future fractures. The use of several types of central nervous system-active drugs, including benzodiazepines, anticonvulsants, antidepressants, and opioids, have all been associated with increased risk of fracture. However, it is unclear whether such an increase in risk is related to an effect of bone mineral density or to other factors, such as increased risk of falls. We sought to examine the relationship between bone mineral density and the use of benzodiazepines, anticonvulsants, antidepressants, and opioids in a representative US population-based sample. SUBJECTS AND METHODS: We analyzed data on adults aged 17 years and older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Total femoral bone mineral density of 7114 male and 7532 female participants was measured by dual-energy x-ray absorptiometry. Multivariable linear regression models were used to quantify the relation between central nervous system medication exposure and total femoral bone mineral density. Models controlled for relevant covariates, including age, sex, and body mass index. RESULTS: In linear regression models, significantly reduced bone mineral density was found in subjects taking anticonvulsants (0.92 g/cm2; 95% confidence interval [CI]: 0.89 to 0.94) and opioids (0.92 g/cm2; 95% CI: 0.88 to 0.95) compared with nonusers (0.95 g/cm2; 95% CI: 0.95 to 0.95) after adjusting for several potential confounders. The other central nervous system-active drugs-benzodiazepines or antidepressants-were not associated with significantly reduced bone mineral density. CONCLUSION: In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. These findings have implications for fracture-prevention strategies.

AB - PURPOSE: Decreased bone mineral density defines osteoporosis according to the World Health Organization and is an important predictor of future fractures. The use of several types of central nervous system-active drugs, including benzodiazepines, anticonvulsants, antidepressants, and opioids, have all been associated with increased risk of fracture. However, it is unclear whether such an increase in risk is related to an effect of bone mineral density or to other factors, such as increased risk of falls. We sought to examine the relationship between bone mineral density and the use of benzodiazepines, anticonvulsants, antidepressants, and opioids in a representative US population-based sample. SUBJECTS AND METHODS: We analyzed data on adults aged 17 years and older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Total femoral bone mineral density of 7114 male and 7532 female participants was measured by dual-energy x-ray absorptiometry. Multivariable linear regression models were used to quantify the relation between central nervous system medication exposure and total femoral bone mineral density. Models controlled for relevant covariates, including age, sex, and body mass index. RESULTS: In linear regression models, significantly reduced bone mineral density was found in subjects taking anticonvulsants (0.92 g/cm2; 95% confidence interval [CI]: 0.89 to 0.94) and opioids (0.92 g/cm2; 95% CI: 0.88 to 0.95) compared with nonusers (0.95 g/cm2; 95% CI: 0.95 to 0.95) after adjusting for several potential confounders. The other central nervous system-active drugs-benzodiazepines or antidepressants-were not associated with significantly reduced bone mineral density. CONCLUSION: In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. These findings have implications for fracture-prevention strategies.

KW - Anticonvulsants

KW - Antidepressants

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KW - Bone mineral density

KW - Opioids

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