Educate Epileptics on Osteoporosis Risk Factors

Controlling seizures is critical for patients with epilepsy, but side effects of antiepileptic drugs (AEDs) are another tremendous concern.

One silent effect on bone strength can have a life-changing impact if patients develop osteomalacia or osteoporosis. Once bones become soft or brittle, the likelihood of fracture and falls increases.

Pharmacy researchers in New Jersey recently examined epileptics’ awareness of their AEDs’ propensity to leach bone strength. Their study, which appears ahead of print in Epilepsy & Behavior, indicates pharmacists can and should improve counseling for patients taking AEDs.

The researchers assessed the prevalence of osteoporosis risk factors in 260 patients diagnosed with epilepsy who were aged 42 years on average. Approximately 66% had been exposed to AEDs associated with bone loss.

Among participants, 106 had undergone documented dual energy X-ray absorptiometry (DXA) scans. In this sub-group, 52% had low bone mineral density (BMD), and 11% had osteoporosis. These patients were more likely than others enrolled in this study to take calcium and vitamin D supplements.

Participant age is important to note because these patients were younger than most referred for BMD testing in the general population. This implies by the time many epileptic patients are screened, it may be too late to prevent serious bone disease.

Most patients in this study did not engage in bone-protective behaviors, regardless of whether they had undergone a DXA scan or not. As reported in large studies, patients with epilepsy are less likely than the general population to exercise and equally as likely to smoke, and lack of exercise and smoking are risk factors for osteoporosis.

The researchers also found patients had a poor understanding of DXA results and were unable to report them accurately in many cases.

Pharmacists should encourage epileptics to undergo BMD screening if they have risk factors for bone disease, especially if they have taken phenytoin, phenobarbital, carbamazepine, or valproic acid. All health care providers can help patients understand DXA results and recommend bone-protective interventions, such as exercise, calcium-rich diet, calcium and vitamin D supplementation, and smoking cessation.