Abstracts

Fractures, particularly of the axial skeleton, are a major cause of mortality and morbidity in the general population. Osteoporosis and low bone mineral density are often the prelude to fractures. Epilepsy and its treatment adversely impact bone health with potentially negative implications. Patients with epilepsy are at multiple risk for lowered bone density and may be at increased risk for falls resulting either directly from the trauma associated with seizures, or potentially from adverse effects of certain AEDs on balance and gait. Given these theoretical considerations, it is important to determine whether clinically meaningful adverse outcomes on bone health are associated with these treatments. Specifically, it would seem reasonable to speculate that the incidence, and potentially the pattern, of skeletal fractures is increased in patients with epilepsy. However, the characteristics of epilepsy patients sustaining fractures remain to be defined.
The objective of this study therefore was to charactorize the pattern of skelatal fractures in a representative population of patients with epilepsy.
Medical records for the University of Wisconsin Hospitals and Clinics were searched retrospecitively for patients with a diagnosis of epilepsy and who had ICD-9 codes indicating fractures, pathological fractures (fractures associated with clinical and radiological evidence of bone disease, osteoporosis and/or osteomalacia for the 7 year period January 1995 to December 2002. This study was approved by the Univ. of Wisconsin Institutional Review Board.
871 patients with epilepsy had a bone disorder. Increasing age was associated with osteoporosis (57[plusmn] 19 yrs compared to 38[plusmn]22 yrs, p[lt]0.01).Women were twice as likely to have osteoporosis as men (33% females vs. 18% males, p[lt]0.01). Osteomalacia occured mainly in young patients (28[plusmn]11 yrs, p[lt]0.05) and equally by gender.
Fractures occured in 493 (56%), osteoporosis 236 (27%), and osteomalacia in 28 patients. Of the 493 patients with fractures 204 had pathological fractures.Fractures were significantly more common in younger patients (41.8 vs. 45.5 years, p=0.02) and in males (64%) compared to pathological fractures which occured equally in males and females and where there was no age effect.
Fractures, both pathological and non pathological, were a frequent occurence in patients with epilepsy. Surprisingly, 18% of males had evidence of osteoporosis. Furthermore, males were as high a risk for fractures as were females and were at equal risk for pathological fractures as women. This could be an interplay of the unrecognized osteoporosis in males and the possibility that men are more likely to engage in activity assicated with fractures. Further support for this is the finding that younger patients sustained fracturs more frequently overall. These finding emphasize the importance of ensuring optimum bone health in men as well as women. Further analysis assessing the impact of seizures type, AED use with patterns of fractures are warrented.