Metabolic Bone Disease in Young Adults ([lt]40 yrs) with Epilepsy
Abstract number :
2.163
Submission category :
Year :
2001
Submission ID :
921
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
J. Liporace, M.D., Neurology, Thomas Jefferson University Hospital, Philadelphia, PA; S. Ward, M.D., Rheumatology, Thomas Jefferson University Hospital, Philadelphia, PA; M. Nei, M.D., Neurology, Thomas Jefferson University Hospital, Philadelphia, PA; J.
RATIONALE: The epilepsy population is at risk for metabolic bone disease and subsequent fracture. Bone reaches peak mass in the third decade of life. People with epilepsy are rarely offered early measurement of bone health. We sought to evaluate bone density at a young age and determine risk factors for bone disease. Previous studies have suggested a higher risk from hepatic enzyme inducing AEDs (EIAEDs) due to altered calcium and Vitamin D metabolism while others have noted a higher risk from Valproic Acid (VPA), a non-hepatic inducer. We sought to correlate risk of low bone mineral density (BMD) and duration of exposure to these drugs.
METHODS: Out-patients ([lt] 40 yrs old) at the Jefferson Comprehensive Epilepsy Center were offered a DEXA scan. T score (BMD compared to gender matched controls at peak bone mass) at the lumbar spine (L1-L4) and hip were determined. Age, gender, body mass index, duration and type of epilepsy, length of exposure to AEDs (EIAED and VPA), seizure frequency, and bone mineral density (BMD) at the spine and hip were registered in a data base and evaluated by multiple regression. Osteopenia was defined as a T-score of -1 to -2.5, osteoporosis was defined as a T score of -2.5 or lower.
RESULTS: 88 pts were screened.[Table] 13/26(50%) men and 16/62 (25%) women had metabolic bone disease. Low BMD at the spine and hip were correlated with gender (higher in men) and low BMD at the spine was correlated with longer duration of exposure to VPA([beta]=.02, p=0.04). Duration of epilepsy, sz frequency, body mass index, and duration of exposure to EIAED were not correlated with bone disease. For those exposured to VPA 5 yrs or more, only 6/19 (31%) had normal bone health. For those exposed to EIAEDs for 5 yrs or more, 43/64 (68%) had normal bone health.
CONCLUSIONS: Metabolic bone disease is prevalent in young adults with epilepsy. Both genders are affected. A longer duration of exposure to Valproic Acid may be associated with adverse bone health. We suggest screening all epilepsy patients with a DEXA scan.
Disclosure: Consulting - Dr. Liporace, Dr. Sperling, and Dr. Nei are on the Speaker[ssquote]s Bureaus and Consult for Glaxo-Smith Kline, Pfizer, Ortho-McNeil, Novartis, and UCb Pharma.