An explorative literature review of the multifactorial causes of osteoporosis in epilepsy

Diemar, Sarah Seberg; Sejling, Anne Sophie; Eiken, Pia; Andersen, Noémi Becser; Jørgensen, Niklas Rye

doi:10.1016/j.yebeh.2019.106511

Cited by 30 publications

(28 citation statements)

References 88 publications

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“…33,34 Antiseizure medications are commonly prescribed to individuals with epilepsy and are well-established risk factors for skeletal fragility, 35 possibly due to a variety of direct and indirect effects on skeletal metabolism, such as altered vitamin D and calcium metabolism, neurological side effects (eg, gait instability, falls), endocrine disruption, and altered bone turnover. 31 In the current study, the findings were similar for new users with epilepsy when stratified by 12.5-month exposure to antiseizure medication. Interpretations regarding the association with antiseizure medication for the other groups should be done so with caution, as this study was designed to match based on several covariates to EP new users, which included antiseizure medication.…”

Section: T a B L Esupporting

confidence: 68%

“…Antiseizure medication can lead to skeletal fragility through a variety of mechanisms. 31 To determine if the change in preindex fracture to post-index NTFx differed by status of antiseizure medication exposure, unadjusted RRs for NTFx at any site were examined after stratifying each group by antiseizure medication exposure in the 12.5-month pre-index period. Sitespecific effects were not examined due to the small sample size.…”

Section: Sensitivity Analysismentioning

confidence: 99%

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Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy

Whitney

2020

Epilepsia

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Objective: The objective of this propensity score-matched, observational cohort study was to determine the effectiveness of osteoporosis medication on reducing the risk of non-trauma fracture (NTFx) among adults with epilepsy. Methods: Data from 01/01/2012 to 09/30/2015 was extracted from Optum Clinformatics Data Mart. NTFx risk attenuation from 12 months prior to 12 months after the individual's index date was examined for each group of adults ≥50 years of age as risk ratios (RRs with 95% confidence intervals [CIs]). Groups were stratified based on: (1) epilepsy status, as with vs without epilepsy (EP); and (2) if and when osteoporosis medication was first prescribed, as new users (treatment naive), consistent users (osteoporosis medication prescribed in pre-index period), and no users. Comparison groups were matched 1:1 to EP new users (n = 828/group) for demographics, glucocorticoid and antiseizure medication, and the Elixhauser comorbidity index. Difference-indifference analysis compared the change in pre-to post-index NTFx risk among groups as the ratio of the RR (RRR). Results: The pre-to post-index NTFx risk at any site was reduced for EP new users

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Section: T a B L Esupporting

confidence: 68%

Section: Sensitivity Analysismentioning

confidence: 99%

Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy

Whitney

2020

Epilepsia

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“…We found a correlation between injuries and older age in females, a finding that might be attributed to a higher prevalence of osteoporosis in older women [31,32]. However, epilepsy patients in general have a high risk of developing bone disease, caused by ASD intake as well as other factors [33,34]. Accordingly, seizure severity, duration of epilepsy, the use of ASDs known to decrease bone mineral-density, and a family history of fractures have all been identified as risk factors for injuries [23].…”

Section: Discussionmentioning

confidence: 59%

Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures

et al. 2020

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Objective To evaluate the incidence and risk factors of generalized convulsive seizure (GCS)-related fractures and injuries during video-EEG monitoring. Methods We analyzed all GCSs in patients undergoing video-EEG-monitoring between 2007 and 2019 at epilepsy centers in Frankfurt and Marburg in relation to injuries, falls and accidents associated with GCSs. Data were gathered using video material, EEG material, and a standardized reporting form. Results A total of 626 GCSs from 411 patients (mean age: 33.6 years; range 3–74 years; 45.0% female) were analyzed. Severe adverse events (SAEs) such as fractures, joint luxation, corneal erosion, and teeth loosening were observed in 13 patients resulting in a risk of 2.1% per GCS (95% CI 1.2–3.4%) and 3.2% per patient (95% CI 1.8–5.2%). Except for a nasal fracture due to a fall onto the face, no SAEs were caused by falls, and all occurred in patients lying in bed without evidence of external trauma. In seven patients, vertebral body compression fractures were confirmed by imaging. This resulted in a risk of 1.1% per GCS (95% CI 0.5–2.2%) and 1.7% per patient (95% CI 0.8–3.3%). These fractures occurred within the tonic phase of a GCS and were accompanied by a characteristic cracking noise. All affected patients reported back pain spontaneously, and an increase in pain on percussion of the affected spine section. Conclusions GCSs are associated with a substantial risk of fractures and shoulder dislocations that are not associated with falls. GCSs accompanied by audible cracking, and resulting in back pain, should prompt clinical and imaging evaluations.

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“…Patients with epilepsy have increased risk of developing osteoporosis and increased fracture risk that is 2-6 times higher than the general population, independent of seizurerelated fractures (Diemar et al, 2019a). Decreased exercise, a more sedentary indoor lifestyle, and use of anti-epileptic drugs (AEDs), which can lead to impaired coordination and disrupted calcium/vitamin D metabolism, may contribute to poor bone health (Kobau et al, 2004;Shellhaas and Joshi, 2010;Diemar et al, 2019b).…”

Section: Epilepsymentioning

confidence: 99%

Effects of Neurological Disorders on Bone Health

2020

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Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how bone may affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment.

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An explorative literature review of the multifactorial causes of osteoporosis in epilepsy

Cited by 30 publications

References 88 publications

Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy

Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy

Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures

Effects of Neurological Disorders on Bone Health

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