Reply to: Antidepressants and Fracture Risk: Is There a Real Connection?

To the Editor:
Dr Sundaresh and Dr Singh raise several interesting points with respect to our recently published article, “Multinational Investigation of Fracture Risk with Antidepressant Use by Class, Drug, and Indication.”1 It is important to reiterate the important messages from this article, namely that (1) antidepressants within the same class do not have the same risk in relationship to fractures, an assumption that is made in most epidemiological studies of antidepressant medications, (2) choice of drugs within a class and dose prescribed vary by jurisdiction, which may explain differences in study results in different populations, and (3) treatment indication may be an important modifier of the risk.