Abstracts

The incidence of osteoporosis varies amongst different ethnic groups, because of variations in skeletal architecture, bone turnover, and bone mass, with genetic factors also playing a role. Osteoporosis is more common amongst Caucasians as compared to African-Americans. Patients with chronic epilepsy are at greater risk for bone loss, not only due to enzyme inducing anti-epileptic drugs, but also due to other causes like decreased physical activity, poor dietary intake, and dietary restrictions like the ketogenic diet. The purpose of this study was to evaluate whether African-Americans with chronic epilepsy are at less risk for developing bone loss as compared to Caucasians., A retrospective chart review was performed on all patients followed at the Epilepsy Center at Drexel University College of Medicine. Inclusion criteria were: age greater than 18 years, patients on any anticonvulsant medication for at least two years, at least one DEXA scan performed two years after initiation of treatment, and being either of African-American or Caucasian race. We compared the prevalence of osteopenia/osteoporosis in each ethnic group., 210 charts were reviewed and 49 met the inclusion criteria. Of these 26 were African-Americans and 23 were Caucasians. Mean age for the entire population was 50.02 years (range 23 to 83), with the mean age for African-Americans being 52.07 years and for the Caucasian group being 49.6 years. 24 were female (14 of these were African-American) and 25 were male (11 of these were African-American). There was no statistically significant difference in the prevalence of osteoporosis/osteopenia between the two ethnic groups, with 17 African-American patients (8 males) and 15 Caucasian patients (10 males), representing 65% in each group, being found to have decreased bone mineral density on DEXA scan as defined by the WHO criteria (chi square = 0.083; p = 0.773). The average T value (the lowest T value at either the lumbar spine, the femoral neck, or the distal wrist) in Caucasians was -1.98, whereas in African-Americans, it was -2.33. Of all patients, 20 were treated for more than 10 years with AEDs, 13 of these were African-Americans. 14 of these 20 (70%) had decreased bone density , 9 of whom were African-Americans. 18 out of 29 patients on AEDs for less than 10 years had decreased bone mineral density (62%). Duration of treatment did not correlate with bone loss (chi square = 0.32, p [lt] 1), There was no statistically significant difference in bone mineral density between the African-American and Caucasian patient groups with chronic epilepsy. The most likely reason for this is that decrease in bone mineral density in patients with chronic epilepsy is multifactorial. To investigate if ethnicity is a protective factor against bone loss secondary to chronic AED use, a prospective study needs to be undertaken.,