Jeannette Y. Wick, RPh, MBA, FASCP
Less than a quarter know that most fractures in epilepsy patients are unassociated with seizures, according to a recent study.
Patients who take antiepileptic drugs (AEDs) are at increased risk for falls and fractures. Many have no idea, according to the results of a study
published in the July 10, 2012, edition of Neurology
The researchers gave questionnaires to 150 epilepsy patients who were taking AEDs and attending a clinic staffed by epilepsy specialists and located in an epilepsy research center. The participants averaged 30 years of age and their median duration of AED treatment was 20 years. The researchers created a control group of 506 age- and gender-matched participants to compare fracture episodes.
Their results showed that only 30% of the epilepsy patients taking AEDs were aware that the medication puts them at increased risk for bone fractures, falls, negative effects to their bone metabolism, and reduced bone mineral density. Additionally, just 23% knew that most fractures in epilepsy patients are unassociated with seizures. Indeed, the study found that with increasing duration of AED use, fall risk increased independent of other risk factors.
Previous research has demonstrated that, compared to non-AED users, users have a significantly increased risk of fracturing sites in their spine, clavicles, and ankles. In this study, 31 epilepsy patients (21%) experienced a total of 48 bone fractures over the study’s duration, confirming that bone fractures are a risk. Non-seizure fractures accounted for 69% of all fractures in the study.
Falls were a common event among epilepsy patients in the study, and the fall-to-fracture ratio was quite high. Most of the falls documented in the study occurred with no warning during regular activities of daily living, and very few participants identified a cause or an obstacle associated with a fall.
Of further interest to health care professionals: 70% of patients wanted to learn more about the effects of AEDs on bone health. Based on this result, the authors concluded that patients were likely to be receptive to new and more effective education approaches. Since the best predictor of a future fall is a past fall, educating AED patients about risk is critical.
In an accompanying editorial
, Alison Pack, MD, MPH, highlighted future research needs: “Additional well-designed controlled studies are needed to better understand the effect of epilepsy and AED therapy on osteoporosis and fall and fracture risk. Future studies should determine the differential effect of specific AEDs, particularly given the availability of multiple AED agents."
Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.