Abstracts

RATIONALE: At the end of this presentation, participants will begin to uderstand how bone density changes over time in epilepsy patients with metabolic bone disease.
METHODS: Epilepsy patients followed at the Jefferson Epilepsy Center found to have metabolic bone disease on a prior dual energy X-ray absorptiometry (DEXA) scan were offered a follow up DEXA scan after a minimun of one year from the inital screening. Yearly interval change of bone mineral density (BMD) at the hip and lumbar spine were evaluated, along with treatment of bone disease, and the relationship to menopause. Osteopenia was defined as a T score less than -1 S.D. and osteoporosis was defined as a T score less than -2.5 S.D. compared to gender matched controls at their peak bone mass.
RESULTS: Fourteen patients had serial Dexa scans, including 12 women and 2 men. Age ranged from 32-68, mean 46.9. Two patients were black, 12 were Caucasian. Six women were post menopausal. Nine patients had partial epilepsy, 3 had generalized epilepsy. Duration of epilepsy was 2-46 years, mean 27.5 years. Monthly seizure frequency was 0-6, nine pateints were seizure free. There was one smoker.
Four patients had osteoporsis and 10 had osteopenia identified on the initial scan. Repeat scans were obtained after 12-31 months (mean 20.5) on the same type of machine. Repeat DEXA revealed that 3 had osteoporosis, 8 had osteopenia, and 3 had normal bone health.
Yearly interval change revealed stable/improved BMD in 8/14 (57%) patients. The yearly mean interval change in BMD was 3% at the lumbar spine and 5.7% at the hip. Of the 6 with a decline in BMD, four were post menopausal. The yearly mean interval change in the post menopausal women was -2.3% at the spine and -0.8% at the hip.
All patients were supplemented with 1200-1800 mg calcium and 800 IU of Vit D after the inital abnormal scan. Two received Fosamax. One patient had her AED changed due to concerns about bone health, but the majority did not.
CONCLUSIONS: While epilepsy patients are at greater risk for bone loss, they may also gain bone quickly. Calcium and Vitamin D supplementation typically stablize/improve bone health in epilepsy patients with bone disease, despite on-going treatment with AEDs. Post-menopausal women are at greatest risk for continued decline in bone health.
Additional studies are needed to determine if bone health may normalize after longer treatment duration or with bisphosphonate therapy. We suggest serial DEXA scans at 18 month intervals in patients with abnormal bone health.