Abstracts

Rationale: Childhood and adolescence are critical periods of bone mineralization. Peak bone mass is achieved between 2nd and 3rd decade of life after which it reaches a plateau. A lower peak bone mass acquisition during this vulnerable period may increase future fracture risk. Epilepsy and treatment with antiepileptic medications increases the risk for fractures via multiple mechanisms. Screening for bone health in this population may therefore be important for early identification and treatment of modifiable risk factors. The goal of our study was to document and improve practice patterns in screening for bone health in this high risk group among a group of academic pediatric epileptologists and neurologists. Methods: A survey was administered electronically. The survey included questions on whether epilepsy care providers’ at our center monitored risk factors, lifestyle changes, supplemented Calcium and Vitamin D, obtained screening tests such as Vitamin D levels and Bone DXA scans, and referred patients to a bone health clinic. They were also asked to identify possible limiting factors for not providing optimal bone health care. The survey questionnaire classified patients into a high risk group that included symptomatic patients and patients with cerebral palsy who are non-ambulatory, non-weight bearing and a low risk group who are ambulatory and weight bearing, with idiopathic partial and or generalized epilepsy and new onset epileptics just started on anti epileptic treatment. Antiepileptic drugs were separated out as enzyme and non enzyme inducers. The responses were either yes, no or sometimes. Results: 14 out of 25 (56%) care providers returned the survey questionnaire. We identified that the major limiting factors for improved screening for bone health included time constraints (64%), a belief that this is a primary care pediatric issue (55%), and lack of standardized screening and treatment protocols (82%). Conclusions: While many answers are awaited in optimizing bone health in patients with epilepsy, we have begun attempts to improve screening in our epilepsy clinic, as well at a primary care level, by addressing the limitations identified in the practice survey and are implementing the following measures: 1. Time constraints: The patient pre-visit history intake form has been modified to include additional screening questions such as daily exercise, sun light exposure, dietary calcium, vitamin D intake, and a prior history or family history of fractures. 2. Primary care issue: We have begun educating local primary care providers by using a multidisciplinary approach with referrals to endocrinologists and the bone health clinic, as well as sharing the American Academy of Pediatrics guidelines on optimizing adequate calcium and vitamin D intake in adolescents and children. (Pediatrics. 104 (5): 1152-1157, 1999, Pediatrics 122: 1142-1152, 2008) 3. Lack of standardized protocols: An algorithm has been proposed within our group as a standardized screening protocol for optimizing bone health.