Abstracts

Osteopenia and pathologic fractures occur in chronically treated older patients with epilepsy. Controversy persists if osteopathy results from complications of epilepsy and its treatment or merely reflects age-dependent bone disease. Thus, we examined BMD in children with treated epilepsy to determine if an osteopenia occurs in youth. Age-normalized total body BMD-z-scores (Lunar[reg]) were compared in patients 8-18 years treated for epilepsy and with healthy controls. Exclusion: non-ambulatory patients, chronic disease or known bone adverse medications. Activity and calcium intake were examined. IRB compliant consent was obtained. 34 patients (age 13.37[underline]+[/underline]2.7yrs) were compared to 24 controls (13.49[underline]+[/underline]2.99yrs) of comparable calcium intake, activity levels, height, weight, and gender. Patients had BMD-z-scores -0.31 compared to +0.71 controls (p=0.008). ANOVA examination of height percentiles remained significant between groups (p=.036). Valproate and enzyme-inducer carbamazepine were most frequently prescribed in these patients, although sample size limited examination of individual AED specific bone effects. Importantly, 23% (8 of 34 patients) had BMD [lt]-1SD vs. 0% for controls (p=0.01). Also 34% of controls had [gt]+1SD vs. 17% of patients (p=.12). Even children with treated epilepsy experience significant osteopenia, suggesting that epilepsy and/or its treatments are primary determinants of either failure to accrue normal BMD or induce accelerated bone loss. The expected impact of such reduction in BMD is likely be a significant increase in future pathological fracture rates. Further study is required to determine epilepsy factors that can be modified or identify AEDs without an osteopenic effect. (Supported by Investigator initiated grant from GlaxoSmithKline.)