Abstracts

Rationale: A 2007 study performed at Montefiore Medical Center, Comprehensive Epilepsy Center (Bronx, NY) identified high prevalence of reduced bone density in an urban population of patients with epilepsy, and suggested that bone mineralization screenings should be regularly performed for these patients.1 We conducted a long-term follow up study to determine whether bone mineral density (BMD) loss, osteoporosis, and fractures have been successfully treated or prevented. Methods: In the current study, we analyzed patients from the 2007 study1 who had two dual-energy absorptiometry (DXA) scans that were performed at least 5 years apart. Additional information was gathered for each patient through chart review, and included medical history, T-scores from DXA scans, anti-seizure medications (AEDs) used and bone loss treatment. We used the World Health Organization (WHO) criteria to diagnose patients with osteopenia or osteoporosis, and calculated each patient’s probability of developing fractures with the Fracture Risk Assessment tool (FRAX).2 Results: 81 patients met inclusion criteria - 44 female (54.3%), median age at second DXA scan 52 years (Table 1).  Median time between DXA scans was 9.40 years (range 5.0 - 14.7 years). Overall, 45 patients (55.6%) reported a lower T-score at the femoral neck at their second DXA scan than at their initial one. Based on WHO criteria, 24 patients (29.6%) had osteopenia at the femoral neck and 14 (17.3%) had osteoporosis at this site at the time of their second DXA scan. Eight of those who developed osteopenia and 10 of those who developed osteoporosis did so after their first DXA scans. Based on the first DXA scan, the FRAX calculator estimated that none of our patients had a 10-year risk of more than 20% for developing major osteoporotic fracture (hip, spine, forearm or humeral fracture). However, in our population, 11 patients (13.6%) sustained a major osteoporotic fracture after their first DXA scan. Of these patients with new fractures, 9 (81.8%) took AEDs known to be associated with bone loss, and 8 (72.7%) took treatment to prevent bone loss. Conclusions: Despite being routinely screened for bone mineral density loss, 12.3% of our patients with epilepsy developed osteoporosis (femoral neck) and 13.6% suffered new major osteoporotic fractures. This observation is especially important as patients with epilepsy are at high risk for falls and trauma. These findings suggest the need for strict treatment algorithms for patients with epilepsy who present evidence of bone loss, particularly in the setting of AEDs known to decrease BMD. Funding: We did not receive any funding in support of this abstract.References:1   Lado F1, Spiegel R, Masur JH, Boro A, Haut SR. Value of routine screening for bone demineralization in an urban population of patients with epilepsy. Epilepsy Res. 2008 Feb;78(2-3):155-602    Kanis JA on behalf of the WHO Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. (https://www.sheffield.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf)