A test to evaluate bone mineral density could provide physicians an opportunity to educate their patients about their risk for osteoporosis.
BALTIMORE—A majority of people with epilepsy do not take steps to protect their bones, such as performing weight-bearing exercise and taking vitamin and mineral supplements, investigators reported at the 65th Annual Meeting of the American Epilepsy Society. Although more than half of people with epilepsy had low bone mineral density, 63% of patients correctly reported the results of their dual energy x-ray absorptiometry (DXA) scan, according to the study.
Risk Factors for Osteoporosis in Patients With Epilepsy
Between 30% and 50% of patients with epilepsy have low bone mineral density. People with epilepsy have a risk of bone fracture that is two to six times greater than that of the general population. In addition, the chronic use of antiepileptic drugs (AEDs) is associated with bone loss.
Despite these factors, relatively few studies have examined traditional risk factors for osteoporosis in people with epilepsy, according to Brenda Y. Wu, MD, PhD, Assistant Professor of Neurology at UMDNJ-Robert Wood Johnson Medical School in Piscataway, NJ. She and her colleagues decided to identify high-risk behaviors and characteristics for developing osteoporosis in patients with epilepsy. The group also sought to assess patients’ awareness of their risk for osteoporosis, as well as risk factors for low bone mineral density.
The team administered a survey to 260 patients with epilepsy between June 2008 and January 2011. Nearly 52% of the patients were female, 62% of them were Caucasian, and their mean age was about 42. The survey asked patients about their history of fractures, intake of calcium and vitamin D, exercise habits, smoking status, exposure to sunlight, use of AEDs, perceived DXA scan result, and perceived bone health. The investigators also reviewed actual DXA scan results from patients’ charts or database.
The team also compared the behavior of patients who reported completing a DXA scan to that of patients who did not. Other analyses compared patients with low bone mineral density to those with normal bone mineral density, patients with poor seizure control to those with good seizure control, men to women, and patients with a perception of poor bone health to those with a perception of good bone health.
At-Risk Patients Are Not Protecting Themselves
Of the 260 patients, 38% had a history of bone fracture, but less than half of all patients engaged in osteo-protective behavior. Of 106 patients who had a DXA scan, 52% had low bone mineral density and 11% had osteoporosis.
The patients who reported having a DXA scan tended to be older, more likely to take calcium or vitamin D supplements, and have better seizure control than the other patients. Gender, BMI, and the number of years with seizures were significant factors for loss of bone mineral density in the left femoral neck. BMI was the only significant factor for loss of bone mineral density in the spine.
Because most patients with epilepsy are not protecting their bones, physicians must make a greater effort to educate their patients, the investigators concluded. “Providing education is important, as more than half the [patients with epilepsy] had low [bone mineral density] and did not remember their DXA results correctly,” said Dr. Wu. “Ordering a DXA is an opportunity for education regarding the importance of adequate calcium and vitamin D supplementation, exercise, and smoking cessation,” she added.
Various factors complicate efforts to prevent osteoporosis among patients with epilepsy. Many patients do not like to take additional pills (ie, calcium and vitamin D supplements), some have difficulty swallowing them, and others may forget to take them. In addition, calcium supplements may entail the risk of developing kidney stones. The cost of supplements may also be problematic because calcium and vitamin D pills often are not covered by prescription plans. “The optimal prophylaxis of osteoporosis in patients with epilepsy is still under investigation,” Dr. Wu told Neurology Reviews.
—Erik Greb