Abstracts

RATIONALE: Osteoporosis and the associated morbidity is a major burden on the economy (1). It has been recognized that especially post-menopausal Caucasian women are at risk for developing osteoporosis (1). Recently, women with epilepsy have been identified as being at even greater risk for this disease. This is partially due to antiepileptic drugs (AED[ssquote]s) having a negative effect on the bone density (2). The risk for men in general and especially for men with epilepsy is not well recognized. We are trying to demonstrate that men with epilepsy would benefit from early screening for osteoporosis and potentially from calcium and vitamin D supplementation.
At the end of this activity the participants should be able to recognize the risk for men with epilepsy to develop osteoporosis and apply treatment modalities.
METHODS: Retrospectively we analyzed the charts of 50 epileptic men (age range 18-71, mean age 41) that were seen in our epilepsy clinic. We also interviewed these patients regarding their calcium intake, exercise habits and whether they supplemented calcium and/or vitamin D. Overall, 15 primary and secondary risk factors that have been associated with an increased risk for developing osteoporosis were evaluated (1).
RESULTS: Of these 50 men, all had taken at least one of the AED[ssquote]s associated with lowering bone mass at one point of their disease. Onset of epilepsy was before the age of 25, which is the age of highest bone mass, in 74% of patients. Only 18% of patients performed adequate exercise and only 12% ingested the daily recommended calcium amount of 800-1200 mg. An additional handicap prevented 34% from getting adequate exercise. A total of 2 patients were on long term steroids one for Rasmussen[ssquote]s encephalitis and one for CNS sarcoid. Of the 50 patients 10% had a dexascan performed, which showed signs of osteopenia/ osteoporosis in 3 patients, 1 had normal bone mass for age and one had increased bone density. The patients with decreased bone mass were 32 years, 47 years and 52 years and all had their epilesy since early childhood. Calcium supplementation was taken by 14% of all patients, 4% took vitamin D and 4% took alendronate. The only patients that took supplementations were on chronic steroids or had proven loss of bone mass.
CONCLUSIONS: Men with epilepsy appear to be at risk for developing osteoporosis even at an early age. All of them have taken at least one of the older AED[ssquote]s, that have been associated with decreased bone density (2), at some point of their illness. A lot of them have had epilepsy since early childhood, taking AED[ssquote]s before they had accumulated their peak bone mass. Epilepsy seems often to be associated with other co-morbidities, preventing the patient from exercising sufficiently to prevent osteoporosis. However, further studies on the effect of AED[ssquote]s, especially the newer ones, on bone metabolism are needed. Men with epilepsy and especially those with epilepsy since childhood would benefit from early screening for osteoporosis as well as supplementation of vitamin D and calcium to prevent osteoporosis.
References:
1. Osteoporosis Prevention, Diagnosis and Therapy. NIH Consens Statement 2000 March 27-29; 17(1):1-36
2. Valimaki MJ et al. Bone mineral density measured by dual-energy x-ray absorptiometry and novel markers of bone formation and resorption in patients on antiepileptic drugs. J Bone Miner Res 1994;9:631-637
(Disclosure: Honoraria - GSK, Cyberonics, Ortho-McNeil, Novartis)