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Abstract
Objective: To evaluate fractures and falls in epilepsy patients taking antiepileptic drugs (AED) and to assess their awareness of AED-related bone health, falls, and fracture risk.
Methods: A cross-sectional study was conducted in epilepsy patients taking AEDs and in nonepileptic non-AED users. Information on falls and fracture history was collected.
Results: A total of 150 AED users were compared with 506 non-AED users. Users had greater odds of fracture at spine (odds ratio [OR] 3.92; confidence interval [CI] 1.08–14.16; p = 0.037), clavicle (OR 3.75; CI 1.24–11.34; p = 0.019), and ankle sites (OR 2.34; CI 1.01–5.42; p = 0.048), increased odds for osteoporosis (OR 4.62; CI 1.40–15.30; p = 0.012), and fracture occasions (OR 2.64; CI 1.29–5.43; p = 0.008). We estimate that with every year of AED use the odds of fractures increase by 4%–6%, or 40% per decade for any fracture (OR 1.40; CI 1.02–1.91) and 60% for seizure-related fractures (OR 1.63; CI 1.10–2.37). Non-seizure-related fractures (69% of cumulative fractures) occurred more than seizure-related fractures during therapy. Female users, compared to female nonusers, had more non-seizure falls (31% vs 17%, p = 0.027) and multiple falls (18% vs 5%, p = 0.028) in the preceding year. Fewer than 30% of epilepsy patients knew of the association of AED use with increased risk for fractures, decreased bone mineral density, or falls.
Conclusions: Epilepsy patients taking AEDs had a higher risk of fractures, which was highest in those with longer-term AED exposure. Female AED users had a higher prevalence of falls than matched nonusers. Awareness among epilepsy patients regarding risks of falling and fractures was low.
GLOSSARY
- AED=
- antiepileptic drug;
- BMD=
- bone mineral density;
- CI=
- confidence interval;
- HREC=
- Human Research Ethics Committee;
- MWU=
- Mann–Whitney U;
- OR=
- odds ratio;
- RMH=
- Royal Melbourne Hospital;
- χ2=
- Chi-square test
Footnotes
Study funding: Supported by The Department of Medicine, University of Melbourne.
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Editorial, page 119
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Supplemental data at www.neurology.org
- Received June 13, 2011.
- Accepted December 8, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
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