Abstracts

Exposure to enzyme inducing antiepileptic drugs has been recognized as having affecting bone health, specifically osteopenia and osteoporosis in patients with epilepsy. The data has investigated this affect predominately in women with epilepsy, and moreover, postmenopausal women. Little data are available bone health in men with epilepsy. The purpose of this abstract is to present data collected from male patients with long standing epilepsy and exposure to enzyme inducing antiepileptic medications. Identifying patients with a long history of epilepsy and exposure to enzyme inducing antiepileptic medication(s) at routine visits to the seizure clinic is being undertaken at the Boston Veteran[rsquo]s Hospital. The patients are then referred for bone density evaluation of hip and lumbar spine by DXA scan to determine presence of osteopenia and /or osteoporosis(T scores).All scans are conducted using a single scanner . 25 subjects were evaluated. Ages ranged from 35-83 years of age. Duration of epilepsy spanned 4- 50+ years. All patients had exposure to at least one enzyme- inducing drug (17 to one, 8 with more than one) during the course of treatment. All were currently on at least one enzyme inducing medication.76% demonstrated osteopenia/porosis. 44% demonstrated involvement of both hip and lumbar spine. Eight patients demonstrated either hip or lumbar spine involvement, 5 with hip and 3 with lumbar spine only. Six patients demonstrated no abnormality of bone density, despite 6-36 yr history of epilepsy.Of these patients, 2 were currently on dual enzyme inducing drugs, with 18 and 36 year history of epilepsy; the remaining 4 were on a single enzyme inducing agent, with 6 to 14+ year history of epilepsy. Levels of 25 OH Vit D and parathyroid hormone levels were not consistently obtained. 52% of these patients are currently receiving calcium and Vitamin D supplementation. Risk of enzyme inducing antiepileptic medications on bone density is not a gender specific phenomenon. The number of drug exposures does not seem to be indicative of increased risk. The duration of epilepsy also did not appear to be a predictor, as one subject had only a 4-year history of epilepsy while others with 6-36 year history showed no evidence of abnormal bone density. Given these factors, men and women with epilepsy and exposure to enzyme inducing antiepileptic drugs should be screened for abnormalities of bone density early on, perhaps as early as 2 years of exposure. Laboratory tests should also be obtained determining 25 OH Vit D levels and parathyroid hormone levels at the very least. Referral for treatment should be undertaken as soon as abnormality is detected. Information is not yet available on the newer antiepileptic medications and their effects if any on bone health. Patients exposed to these medications should be equally evaluated. Data collection continues and will be added to this database.