Abstracts

Rationale: People with epilepsy (PWE) have a two-fold risk of sustaining a fracture compared to the general population. Long-term use of antiepileptic drugs (AED) has been identified as one of the precipitating factors for bone loss. This study aims to assess 1) high risk behaviors and characteristics for developing osteoporosis 2) patients awareness of their risk 3) precipatating factors for low BMD in the AP Spine and Left Femoral Neck (LFN). Methods: PWE attending the Epilepsy Clinic of UMDNJ-Robert Wood Johnson Medical School in New Brunswick, NJ were asked to complete a survey tool. The survey included questions regarding: patient demographics, fracture history, frequency of exercise, dietary intake of calcium, supplement intake, frequency and duration of sunlight exposure, antiepileptic medication use, DXA Scan result, and perception of bone health. DXA Scan results were retrieved from patient s charts. All protocols were reviewed and approved by the institutional review board of UMDNJ and Rutgers University. ANCOVA analysis was used to identify the significant factors that precipitating bone loss.Results: Over a 2 year period, 260 subjects were surveyed (F=51.5%, average age= 42, 62% White, 14% Black, 14% Hispanic, 9% Asian, 1% Other). Of these, 33% obtained >3 servings of calcium-rich food daily (> 900 mg), 25% took calcium and vitamin D regularly, 28% engaged in weight-bearing exercise >3x/ week, 23% indicated a family history of osteoporosis, 38% had a prior fracture, and 17% smoked. Nearly half of subjects completed a DXA Scan, and 40% of these had low bone mineral density (BMD, T-score < -1.0SD). The majority of subjects (66%) had been previously exposed to an AED reported possibly related to BMD (carbamazepine, phenytoin, phenobarbital, and divalproate). Subjects who thought they had a DXA Scan were more likely to regularly take Calcium and Vitamin D supplements (p<0.004) and had better seizure control (p<0.03) than those who thought they did not have a DXA Scan. Subjects who thought their BMD low were associated with a lower BMI (p<0.008) and were more likely to have poor bone health perception (p<0.004) compared to those who thought they had normal BMD. Only 63% of subjects correctly perceived DXA results. Seizure years (p=0.034), gender (p=0.049), and BMI (p<0.001) were identified as significant factors at 95% level for BMD reduction at LFN. BMI also showed significant association at AP Spine BMD. Conclusions: The study suggests that 1) Majority PWE are not engaging in bone protective behaviors. 2) PWE who have undergone a DXA scan may be more likely to take calcium and vitamin D supplementation but not other osteoprotective behaviors. 3) Length of antiepileptic therapy and gender are two independent precipitating factors for BMD reduction but only at the hip. 4) PWE possible carry a similar risk as general population on bone loss at lumbar spine.