Abstracts

Rationale: Antiepileptic drugs (AEDs), primarily enzyme inducing, are associated with a reduction in bone mineral density and data has shown that adults with epilepsy have a two to six fold greater risk of fractures than the general population. While there is limited data in pediatric patients, fractures secondary to AEDs are a major concern as these patients are being treated during time of highest bone mineral accrual. The objective of this study is to evaluate the prevalence of fractures in pediatric patients on an antiepileptic drug. Methods: This study is a retrospective, cohort study and was approved by the Institutional Review Board of Baylor College of Medicine. Patients < 18 years of age at initiation of therapy on at least one antiepileptic drug (AED) with a documented fracture in the electronic medical record at Texas Children's Hospital from 2011 to 2014 were included. Data collection included demographics, antiepileptic drugs and doses, ambulatory status, concomitant medications affecting bone health, ketogenic diet, and diagnosis of cerebral palsy, epilepsy, osteopenia, and/or osteoporosis. Data has been secured and maintained confidentially. Data collected is currently being analyzed using statistical tests appropriate to the type of data. Results: A total of 10,153 patients were included (female 49.7%). Concomitant diseases include epilepsy (52.6%), cerebral palsy (8.3%), epilepsy + cerebral palsy (6.9%), osteoporosis (0.2%), and osteopenia (0.3%). Preliminary data analysis shows a total of 113 patients (1.1%) experienced a fracture while on an antiepileptic drug. The mean time from initiation of AED to time of fracture was 1.6 years. Proton pump inhibitors and corticosteroids were the most common concomitant drugs. Additionally, < 10% of patients were on calcium or vitamin D supplements. Conclusions: Patients on an AED had a 1.1 % incidence of fractures. Patients on enzyme inducing AEDs were two times more likely to experience a fracture. Patients with cerebral palsy and epilepsy were three times more likely to experience a fracture. Vigilant monitoring should be employed for at risk patients. Regular monitoring of calcium and vitamin D levels may be warranted, further studies are needed to evaluate the roll of prophylactic calcium and vitamin D supplements. Funding: n/a