Epilepsy patients unaware of fracture risk

By Eleanor McDermid

Few patients with epilepsy are aware that taking anti-epileptic drugs (AEDs) puts them at increased risk for falls and fractures, report researchers.

"This study… highlights the need for better education on the risk of fracture, falls, and adverse effects of bone health among persons with epilepsy treated with AEDs," says Alison Pack (Columbia University, New York, USA) in an editorial accompanying the study in Neurology.

The study included 150 epilepsy patients who were using AEDs, and just 30% of these knew that AED use is associated with increased risk for falls, fractures, decreased bone mineral density (BMD), and a negative effect on bone metabolism. Just 23% knew that most fractures in epilepsy patients are not related to seizures.

This was "despite our study population attending specialist epilepsy clinics at a center with a research interest in this area," comment John Wark (University of Melbourne, Victoria, Australia) and colleagues.

However, 70% of the patients said they wanted to know more about the impact of AEDs on bone health. This suggests that "more effective education strategies are not only warranted, but may also be well-received," says the team.

The findings also serve to confirm the increased fracture risk in patients taking AEDs, which occurred in 31 of the AED users in the current study. They were aged a median of 30 years and had been taking AEDs for nearly 20 years.

Compared with 506 age- and gender-matched patients without epilepsy, AED users were 4.62-fold more likely to have osteoporosis, and the likelihood for a previous fracture was increased 3.92-fold for spinal fractures, 3.75-fold for clavicle fractures, and 2.34-fold for ankle fractures.

The researchers calculate that each additional year of AED use raised patients' fracture risk by 4% for all fractures and 6% for fractures related to seizures, after accounting for other variables including age. But they note that 69% of fractures were not a direct consequence of a seizure.

In her editorial, Pack says: "Additional well-designed controlled studies are needed to better understand the effect of epilepsy and AED therapy on osteoporosis and fall and fracture risk. Future studies should determine the differential effect of specific AEDs, particularly given the availability of multiple AED agents."

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