Antidepressants Linked to Increased Bone Fracture Risk

Patients over age 50 who take commonly prescribed antidepressants daily are at twice the risk of bone fracture from falling, according to a January 22nd study in the Archives of Internal Medicine. The study concluded with a 95% confidence interval that risk of fracture from low-trauma events such as falling from a standing height increased by 210% when the patient was using antidepressants known as selective seratonin reuptake inhibitors (SSRIs), which include Prozac, Paxil, Celexa and Zoloft on a daily basis.

About 10% of older Americans suffer from depression, and SSRIs are commonly prescribed as treatment because of their presumed "relatively benign side effect profile". Previous studies had noticed a link between falls, fractures and SSRI use, but did not have the ability to control for additional complicating factors.

In this study, 5000 patients over the age of 50 (average age 65) were followed for 5 years. All patients had bone mineral density of their hip and low back measured at the beginning of the study. Patients also agreed to filling out yearly questionnaires regarding falls and fractures, especially "minimal trauma" fractures that occur when falling from a bed, chair, or standing height. All fractures were confirmed via radiography, and occurred everywhere from the forearm to rib, hip, femur and back. Of the 5000 participants, 137 were taking SSRIs continuously throughout the course of the study.

Dr. David Goltzman, the study's senior author and director of McGill University's Metabolic Bone Disease Centre summarized:

"Basically what this shows is that the SSRIs produce a doubling in the risk of developing fractures than if you were not taking them. It's still an association study, but it certainly suggests very strongly that SSRIs can pre-dispose to fractures, probably by reducing the amount of bone and possibly by altering the quality of bone as well."

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Medgadget's 2006 Medical Blog Awards

We are pleased to announce that four of Healthline's blogs have been nominated to receive awards for best medical blog in their category. This is the third annual Medical Weblog Awards conducted by Medgadget, designed to honor those who have made significant contributions to the medical blogosphere. The polling stations are open until midnight on Sunday, January 14, 2007 (PST), and the winners will be announced on Friday, January 19, 2007.

Healthline's blogs and the categories in which they are nominated are listed below:

Best New Medical Weblog Established in 2006 (Click this link to go directly to this polling station)

Fruit of the Womb

Medicine for the Outdoors

Teen Health 411

Best Medical Technologies/Informatics Weblog 2006 (Click this link to go directly to this polling station)

Tech Medicine

Healthline would like to thank Medgadget for undertaking the enormous task of conducting and sponsoring these awards. We'd also like to thank Thinklabs Medical for its sponsorship.

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Guidelines Identify Children with Meningitis

A standard battery of five tests is highly accurate in detecting the difference between viral meningitis and more dangerous bacterial meningitis, according to a report in the Journal of the American Medical Association. The tests are called the Bacterial Meningitis Score, and include review of white blood cell counts, history of seizures, and three tests of fluid surrounding the brain and spinal cord (CSF).

In the study, 1,714 patients were categorized as very low risk by the Bacterial Meningitis Score. Of this group, only two actually had bacterial meningitis, showing the tests to be extremely accurate.

Said principal investigator Dr. Lise E. Nigrovic, an attending physician in pediatric emergency medicine at Children's Hospital Boston:

"The previously published and derived 'decision rule' worked well or better than anything else we could come up with. It's the most accurate clinical prediction rule to discriminate between bacterial and viral meningitis."

Dr. Nathan Litman, director of pediatrics and pediatric infectious diseases at Children's Hospital at Montefiore Medical Center in New York City, added:

"This would support some clinicians - particularly [those] seeing an older child with what looks like viral meningitis - in saying, 'I don't really need to hospitalize this child now, I can follow him as an outpatient... potentially saving costly hospitalization and potentially avoiding initiating an IV line of antibiotics that would be unnecessary."

This research arrived just as Rhode Island government officials ordered 20,000 public school students in three communities to stay home for the rest of the week, after a child attending one of the schools was admitted to a local hospital with a probable case of meningitis. Another student, a second-grader from West Warwick, died from a related disorder, encephalitis, last month. Epidemiologists from the U.S. Centers for Disease Control are already in the communities to talk to school nurses and look for additional cases in local hospitals.

Officials called this level of caution warranted, given how contagious meningitis can be, and how serious it can be when contracted. Dr. Nigrovic said plainly, "Bacterial meningitis is a potentially life-threatening and serious condition which requires intravenous antibiotics at hospital admission."

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