Fractures and Antiepileptic Drug Use in a Large Nursing Home Population
Abstract number :
2.042
Submission category :
Year :
2000
Submission ID :
3201
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Thaddeus S Walczak, Susan Lee Harms, Patricia C Bland, Judith Garrard, Ilo E Leppik, MINCEP Epilepsy Care, Minneapolis, MN; Univ of Minnesota, Minneapolis, MN.
Rationale: Antiepileptic drugs (AEDs) inducing hepatic oxidase systems increase Vitamin D metabolism and may be associated with fractures and osteoporosis more often than noninducing AEDs. Methods: We examined associations between use of inducing AEDs (IND), noninducing AEDs (NONIND), fracture occurrence, and diagnosis of osteoporosis. IND were phenytoin, carbamazepine, phenobarbital and primidone. NONIND were valproate, gabapentin and lamotrigine. Data were drawn from the Minimum Data Set (MDS) and physicians orders at admission in 11,422 patients residing in a large nursing home system. Results: Median age was 81.2 years, 64% were women. 5.6% took only IND, 4.1% took only NONIND. 11.6% suffered a fracture and 6.4% suffered a hip fracture in the 180 days prior to admission. Hip fracture was an active diagnosis in 10.1%, osteoporosis in 11.0%. Hip fracture in the 180 days prior to admission occurred in 4.0% of those taking only NONIND; less than those taking only IND (6.6%, p?.05) and those not taking any AEDs (6.6%, p?.05). Any fractures in the 180 days prior to admission occurred in 7.7% of those taking only NONIND; no different from those taking IND (9.8%, p?.3) but less than those not taking AEDs (11.9%, p?.02). An active diagnosis of hip fracture at admission was noted in 5.5% of those taking NONIND; less than those taking IND (10.3%, p?.01) and those not taking AEDs (10.3%, p?.01). An active diagnosis of osteoporosis at admission was noted in 6.7% of those treated with NONIND; no different from those treated with IND (9.0%, p?.2) but less than those not taking AEDs (11.3%, p?.01). There were no differences in these measures between those taking IND and those not taking AEDs. Conclusion: AEDs were not associated with an increase in either fractures or osteoporosis in this large group of nursing home patients. Fractures were less common with NONIND use than with IND use. Of interest, both fractures and osteoporosis were less common in NONIND use than when no AEDs were used. We are currently investigating whether weight, gender, ataxia, and other factors help explain results in this data set. Reasearch was supported in part by NIH-NINDS Grant P50 NS16308.