Central Nervous System Active Medications and Risk for Fractures in Older Women

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Abstract
USE OF CENTRAL nervous system (CNS) active medications that impair level of alertness and neuromuscular function may increase the risks for falls and fractures in older individuals. However, numerous prior studies1 that examined the relationship between use of these medications and risk of fractures have been limited by their ability to control for potential confounding factors. Many investigations2-7 have been performed using administrative databases that do not contain objective measures of variables that may confound or modify the relationships between medication use and risks for fracture, such as cognition, depressive symptoms, physical function, and bone mineral density. Few studies8 have taken account of confounding by indication, where the association between medication use and the outcome is caused by the indications for drug use. For example, a chronic medical condition such as depression for which a CNS active medication is prescribed may increase the risk for fracture rather than the medication itself.