Abstracts

RATIONALE: Fracture rate is increased in persons with epilepsy. Contributing factors include fractures during seizures, fractures due to clumsiness or falling which may be a reflection of effect of medication neurotoxicity, and fractures due to decreased bone density. We sought to determine the characteristics of lifetime fractures in a group of menopausal women with epilepsy, in order to assess the impact of these contributing factors.
METHODS: Women with epilepsy who were in natural or surgical menopause were surveyed for the history of documented skeletal fractures, whether they occurred prior to or after antiepileptic drug (AED) treatment, or prior to or after menopause, the site of fracture, and the setting in which it occurred (seizure, [dsquote]clumsiness[dsquote] or accidental). Descriptive statistics were used in the analysis.
RESULTS: Fifty menopausal women with epilepsy were surveyed. The mean age was 54.4 years (range 44-64, SD=5.6). Mean age of menopause was 46.2 years (range 23-59, SD-6.0). Ten women had undergone hysterectomy (20%) and 31 women had undergone bone mineral density evaluations (62%). Thirty three total lifetime fractures were reported; 30 subjects had none, thirteen had 1, five had 2, one had 3 and one had 4. Eleven fractures occurred prior to AED treatment and before menopause; seven of these were accidental, one was due to a seizure and two were due to clumsiness. Most fractures occurred in the upper extremity; one was a skull fracture. Twelve fractures occurred on AEDs but before menopause; six occurred during seizures, four were related to clumsiness and two were called accidental. Of these, five fractures occurred in the upper extremity and 4 in the lower extremity. Nine fractured occurred on AEDs during menopause; six were due to clumsiness and two were during seizures (data missing for one). Eight of these fractures occurred in the lower extremities, but were not hip fractures. None occurred off AEDs during menopause (data missing for one fracture altogether).
CONCLUSIONS: Most fractures after the onset of epilepsy and onset of AED treatment were either related to seizures or to clumsiness (possible AED neurotoxicity), compared to fractures before AED treatment in the premenopausal group, in which most fractures were reported as accidental. During menopause on AED treatment, most fractures were in the lower extremities, compared to the premenopausal group not taking AEDs, in which most fractures were in the upper extremities. This data indicates that after the onset of AED treatment, accidental fractures are much less frequent than those likely related to epilepsy, either AED toxicity or seizures themselves.
[Supported by: NIH [ndash] National Institute of Neurological Diseases and Stroke, R01 NS38473]