Abstracts

Rationale: Chronic antiepileptic drug (AED) treatment is associated with reduced bone mineral density, elevated rates of osteopenia and osteoporosis, and increased risk of fracture in adults with epilepsy as compared to the general population. While the exact mechanisms remain unclear, postulated mechanisms include AED exposure, low vitamin D (Vit. D) levels and increased risk of falls. Expert consensus opinion recommends screening for bone mineral density after two years and annual counseling on bone health. We examined the bone health recommendations adopted in the Veteran Health system, since the extent to which recommendations are being followed is unclear. Methods: Among 1,989 veterans with epilepsy, we identified those treated with AEDs for two or more years, and conducted medical chart abstraction to identify bone-health relevant treatment in FY 08, 12, and 14. Data included demographics, AEDs prescribed, and bone health care provided: osteo screening (Vit. D levels, dual-energy x ray absorptiometry scan [DXA] within 5 years of collection period), osteo treatment (Vit. D, bone drugs), and annual counseling on bone health. We classified AED as enzyme inducing (EIAED: carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone), nonenzyme inducing (NEIAED: gabapentin, lacosamide, lamotrigine, levetiracetam, pregabalin, zonisamide), and EI+NEI AED. Topiramate was excluded because of its dose-dependent action; other AEDs also excluded. Results: A total of 1292 met inclusion criteria. Table 1 shows AEDs prescribed, bone health, and VA neurology outpatient care for men and women. More female than male Veterans were screened for bone health. More male than female Veterans received bone treatment. Documented bone health counseling was infrequent for both groups. About half of these cases were receiving care by a neurologist. Females received more screening/treatment than male Veterans (p < .01). Table 2 shows bone health care based on type of AED. A majority of polytherapy cases were managed by neurologists with screening occurring in about half of all AED groups and teaching occurring in about 10%. Conclusions: Bone health screening, treatment, and counseling occur less frequently than recommended. These results are similar to other studies examining quality of care. Further studies are necessary to design and implement tools to improve overall bone health care provided to veterans on AEDs, who are at high risk for bone loss and fracture. Funding: VA Health Services Research and Development, IIR-067-11-2