CHICAGO—Older women who take narcotics or antidepressants have a higher risk of experiencing a nonspinal bone fracture, according to an article in the April 28 issue of the Archives of Internal Medicine, one of the JAMA & Archives journals.

According to information in the article, use of medications that are active in the brain and spinal cord (ie, the central nervous system or CNS) can impair alertness and neuromuscular function and may increase the risk of falls and fractures in older individuals.

Kristine E. Ensrud, MD, MPH, of Veterans Affairs Medical Center, Minneapolis, Minn, and colleagues investigated whether the use of CNS active medications including benzodiazepines, antidepressants, anticonvulsants, and narcotics, increases the fracture risk in older, community-dwelling women. The researchers examined the use of these 4 medications in 8127 women who were at least 65 years old. The women reported their current use of CNS active medications during interviews between 1992 and 1994 and between 1995 and 1996. The women were assessed for fractures using radiological reports until May 31, 1999.

The researchers found that during the average follow up of 4.8 years, 1256 women (15%) had at least one nonspine fracture, including 288 (4%) with first hip fractures. Compared with women not taking CNS active medications, the women in the study taking narcotics were almost 40% more likely to experience nonspine fractures, and women taking antidepressants were almost 25% more likely to experience nonspine fractures. Among women using antidepressants, those taking tricyclic antidepressants and those using selective serotonin reuptake inhibitors (SSRIs) had similar fracture rates.

The researchers also found that women taking antidepressants compared with nonusers had a 70% increase in the risk for hip fracture. However, there were no significant associations between the use of benzodiazepine drugs or anticonvulsant drugs and risk of nonspinal fracture.

CHICAGO—Fibrinolytic therapy (intravenous delivery of clot-dissolving drugs) in patients who are 75 years and older with ST-segment-elevation myocardial infarction (STEMI, a type of heart attack) is associated with a reduction in death rates and bleeding on the brain after 1 year, according to an article in the April 28 issue of the Archives of Internal Medicine, one of the JAMA & Archives journals.

According to information in the article, since the late 1980s, reperfusion (opening blocked arteries and restoring circulation and oxygen to parts of the heart) has been the standard treatment for STEMI. Fibrinolytic therapy has been beneficial in some groups of patients with STEMI, but has not been rigorously studied in older populations. However, there is concern that use of thrombolytic therapy in the elderly may be associated with increased risk of fatal bleeding events, such as bleeding in the brain.

Ulf Stenestrand, MD, of University Hospital of Linkoping, Linkoping, Sweden, and colleagues studied the use of fibrinolytic therapy in 6891 patients 75 years or older who had previously experienced a STEMI. Of the patients, 3897 received fibrinolytic therapy and 2994 did not receive fibrinolytic treatment. Patients were selected from the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions which recorded every patient admitted to a coronary care unit in 64 Swedish hospitals during 1995 through 1999.

The researchers found that fibrinolytic therapy was associated with a 13% reduction in the combined end points of death and brain bleeding complications after 1 year.