High prevalence of Vertebral fractures in seizure patients r
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People with epilepsy who take certain medications are at risk for developing osteoporosis and fractures of the vertebrae that commonly go undiagnosed. By using technology available in a bone density scan, at least one fracture was observed in many subjects with bone density in the normal and osteopenic range.

Chronic use of antiepileptic drugs (AEDs), both enzyme-inducing (phenytoin, phenobarbital, carbamazepine, and primidone) and non-enzyme-inducing (i.e., valproate), is recognized as a cause of secondary osteoporosis. The purpose of this study is to describe the prevalence of VF in a cohort of male veterans with epilepsy on chronic AEDs.

The cohort for this study consisted of 146 male veterans who carried a diagnosis of epilepsy and were chronic users of AEDs known to cause osteoporosis. Chronic AED use was defined as receiving an AED for at least 2 years. Subjects were previously seen in the osteoporosis clinic and had been evaluated by a dual-energy X-Ray absormetry (DXA) instrument including morphometric studies following a standard vertebral fracture assessment (VFA) protocol during the same DXA imaging acquisition session.

Results:
--The mean age was 63 years. Low bone mineral density defined as osteoporosis or osteopenia was observed in 29% and 43% respectively.

--At least one VF was observed in 41 % of the subjects who had normal BMD, 54% in the osteopenic range, and 75% in the osteoporotic range.

A significant prevalence of compression fractures in individuals with epilepsy chronically treated with AEDs who had BMDs in the normal and osteopenic ranges was revealed by using a VFA in addition to standard bone densitometric studies. VFA or other imaging methods to assess VF should be included in the assessment of bone health in epilepsy patients taking AEDs, as it can change care guidelines to avoid possible osteoporotic fractures.

Source: https://link.springer.com/article/10.1007/s00198-021-05926-2
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