Abstracts

Rationale: Patients with epilepsy (PWE) have a higher risk of osteoporosis and a greater fracture risk. Despite this, a low percentage of PWE participate in bone protective behaviors. Programs should be developed to improve bone health in PWE. The objectives of this study are to determine how often PWE are being monitored for risk of osteoporosis and to determine the impact of an educational exercise class on risks of falling and osteoporosis in PWE.Methods: All PWE seen by epileptologists at an academic medical center from July 2014 to December 2014 were screened. Patients ages 40 years and older with a history of epilepsy were asked to participate in a Project Healthy Bones class, which was developed by the New Jersey Department of Health. The class is a 6 month weekly exercise and education course designed to improve strength, flexibility, balance and fall risk. Assessments of fall risk, knowledge, and diet are collected at baseline, midpoint and end of study. Data collected on all screened PWE included age, current antiepileptic drugs (AEDs), 25 hydroxy vitamin D (25OHD) concentrations, and dual-energy x-ray absorptiometry (DXA) scan results.Results: 420 PWE were screened with a mean age of 42.6 ± 16.7 (16 to 87) years, with 89% of PWE being less than 65 years old. 52 (12%) patients had a DXA scan result in their chart with 30 (58%) having osteopenia and 9 (17%) having osteoporosis as evidenced by low T-scores in either the femoral neck or spine. Left total femoral T-scores did not correlate with age. 25OHD concentrations were measured in 114 (27%) patients with 30 (26%) having concentrations less than 20 ng/mL and 25 (22%) having concentrations between 20 and 30 ng/mL. Serum levels of 25OHD did not differ between patients on strong enzyme inducing AEDs and those not taking strong enzyme inducing AEDs. 10/36 (28%) patients on strong enzyme inducing AEDs and 11/52 (21%) patients not on strong inducers had serum 25OHD levels less than 20ng/mL. Five PWE and one spouse participated in the class. Average attendance rate was 74%. Scores on quizzes related to fall risks, osteoporosis, and calcium and vitamin D improved by 26% from baseline at midpoint. Functional reach scores significantly improved from baseline to midpoint (p=0.006); all patients had scores below aged-matched norms at baseline and normal scores at midpoint. The amount of time PWE could stand on one leg or in a tandem stand more than doubled in all patients. None of the PWE received 1200 mg - 2000 mg of calcium daily from diet and supplements prior to the program. At midpoint, 3 (60%) PWE were within range.Conclusions: DXA scans may be warranted earlier than the recommended age of 65 in PWE. Low vitamin D levels are common in PWE presenting to an academic medical center regardless of type of AED used and should be assessed in high risk patients. Patients in the class improved their balance, fall risk, diet, and knowledge on osteoporosis by midpoint. Physicians should evaluate patients’ risk for osteoporosis and encourage them to join programs that provide education and exercises designed for bone health.