Fracture risk with use of liver enzyme inducing antiepileptic drugs in people with active epilepsy: Cohort study using the General Practice Research Database
Reads0
Chats0
TLDR
LEI AEDs may increase the risk of fracture in people with epilepsy and in patients at high risk of osteoporotic fracture alternative AED therapy may be appropriate.Abstract:
Purpose Liver enzyme inducing antiepileptic drugs (LEI AEDs) have adverse effects on bone metabolism but it is unclear whether this translates into increased fracture risk. This population based cohort study aimed to evaluate whether treatment with LEI AEDs is associated with increased risk of fracture in people with active epilepsy. Methods The cohort included patients diagnosed with epilepsy and prescribed AEDs while registered at a GPRD general practice during 1993–2008. The hazard ratio with current use of LEI AEDs for fracture at any site and hip fracture was estimated using Cox proportional hazards models. Results There were 7356 fractures (788 hip fractures) in 63259 participants. In women, the adjusted hazard ratio with use of LEI AEDs was 1.22 for fracture (95% CI 1.12–1.34; p p =0.002). In men, the hazard ratio for fracture was 1.09 (0.98–1.20; p =0.123) and for hip fracture 1.53 (1.10–2.12; p =0.011). For every 10000 women treated with LEI AEDs for one year, there could be 48 additional fractures, including 10 additional hip fractures. For every 10000 men treated with LEI AEDs for one year, there could be 4 additional hip fractures. Conclusions LEI AEDs may increase the risk of fracture in people with epilepsy. In patients at high risk of osteoporotic fracture alternative AED therapy may be appropriate. Further information is urgently needed on the safety of valproate and newer AEDs and on strategies to maintain bone health in people who need to be treated with LEI.read more
Citations
More filters
Journal Article
Epidemiology of osteoporotic fractures
TL;DR: Patients with vertebral, hip, distal radius, and proximal humerus fractures are most common among the osteoporosis-related fractures.
Journal ArticleDOI
Longitudinal cohort studies of the prognosis of epilepsy: contribution of the National General Practice Study of Epilepsy and other studies
Simon Shorvon,DM Goodridge +1 more
TL;DR: The National General Practice Study of Epilepsy is reviewed, a prospective population-based cohort study of 1195 patients that was initiated in 1983, and shows that epilepsy has an often good prognosis and the prognosis of febrile seizures is generally good.
Journal ArticleDOI
Association between use of antiepileptic drugs and fracture risk: A systematic review and meta-analysis
TL;DR: A robust association between use of AEDs and fracture risk is suggested (particularly for LEI Aeds), and several specific AEDS such as PB, TPM and PHT may be associated with an increased risk of fracture.
Journal ArticleDOI
Management of epilepsy in women
TL;DR: Understanding of the mechanisms linking seizures and the menopause will help to develop effective therapeutic strategies, and advances in managing epilepsy could improve quality of life for women with this condition.
Journal ArticleDOI
Impact of antiepileptic drugs on bone health: Need for monitoring, treatment, and prevention strategies
TL;DR: Evidence-based strategies regarding monitoring, prevention, and treatment of bone diseases in patients on AED therapy are needed.
References
More filters
Journal ArticleDOI
Epidemiology of osteoporotic fractures
Olof Johnell,John A. Kanis +1 more
TL;DR: There have been several definitions of an osteoporotic fracture, and recently updated definitions have specified fractures occurring at a site associated with low BMD and which increase in incidence after the age of 50 years.
Journal ArticleDOI
Validation and validity of diagnoses in the General Practice Research Database: a systematic review
TL;DR: The range of methods used to validate diagnoses in the General Practice Research Database (GPRD) are investigated, to summarize findings and to assess the quality of these validations.
Journal ArticleDOI
Validity of diagnostic coding within the General Practice Research Database: a systematic review
TL;DR: There was good agreement between disease prevalence and consultation rates between the GPRD and other datasets; however, rates of diabetes and musculoskeletal conditions were underestimated in the G PRD.
Journal ArticleDOI
Calculating the number needed to treat for trials where the outcome is time to an event
TL;DR: The number needed to treat is the number of patients who need to be treated to prevent one additional adverse outcome and this number (with confidence interval) is a clinically useful way to report the results of controlled trials.
Journal ArticleDOI
Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores
TL;DR: In this article, the authors developed and validated two fracture risk algorithms (QFractureScores) for estimating the individual risk of osteoporotic fracture or hip fracture over 10 years.