Elsevier

Epilepsy & Behavior

Volume 9, Issue 4, December 2006, Pages 601-605
Epilepsy & Behavior

Pathological fractures in epilepsy

https://doi.org/10.1016/j.yebeh.2006.08.003Get rights and content

Abstract

Fracture rates in epilepsy are two to three times that for the general population, although the influence of gender and age is not well defined. We examined, over a 7-year period at a single health care center, 750 patients with epilepsy who sustained the fractures. Among these patients, 293 (39%) had pathological fractures and 457 (61%) had traumatic/seizure-related fractures. Pathological fractures accounted for 71% of the 146 patients >60 years, a group traditionally at risk for pathological fractures (P < 0.02). Fractures in epilepsy are distributed with bimodal peaks in the fifth and eighth decades of life, although pathological fractures are a significant contributor across the life span, accounting for 20 to 40% of patients traditionally thought not to be at risk for involutional osteoporotic fractures. Together these findings suggest that epilepsy, and/or its treatment, is a dominant influence in the pathogenesis of fractures and may exacerbate the effects of aging-related involutional osteoporosis.

Introduction

Patients with epilepsy frequently experience injuries resulting from seizure-related falls [1] or trauma occurring in the context of seizure-related impairment of consciousness [2], [3], [4], [5], [6], [7], [8]. Fractures are between two and six times more common in patients with epilepsy than in the general population, with fracture rates in the United States of 2205 per 100,000 person-years [1], [4], [9], [10], [11], [12], [13]. Additionally, antiepileptic medication-related osteopenia may increase the susceptibility to fracture, particularly in women [14], [15], [16]. Institutionalized patients treated for >10 years have a 14-fold increase in pathological fractures at the hip [17]. The relative contribution of low-intensity trauma in pathological fractures and fractures resulting from high-intensity trauma and seizure-related falls, however, remain poorly defined in noninstitutionalized patients.

Accordingly, the study described in this article examined the influence of gender and age on fractures in epilepsy. The specific issues of interest include: (1) distribution of fractures in general by age and gender, and (2) distribution of pathological and traumatic/seizure-related fractures by age and gender.

Section snippets

Study design, patients, and analysis

A retrospective analysis was performed at our tertiary care facility of all patients who had epilepsy and sustained a fracture over a 7-year period ending in 2003 using ICD-9 codes for fractures, pathological fractures, and osteoporosis or osteomalacia. The diagnosis of a bone disorder was made by the treating physician and was based on clinical and laboratory criteria supportive of the diagnosis. Clinically significant osteoporosis was defined as reduced bone density associated with either

Results

Over the 7-year period, a total of 750 patients with epilepsy sustained fractures. The majority (61%) were traumatic/seizure-related fractures (Fig. 1). The highest distribution of fractures (19%) occurred between ages 40 and 49 (Fig. 2), with a reduction in representation in subsequent age groups. However, a second lower peak (8.4%) was observed in those between ages 70 and 79.

Gender distribution in this cohort with fractures was significantly different. In those less than 50 years of age,

Discussion

Age and gender appear to exert powerful influences on the mechanism and pathogenesis of fractures in epilepsy.

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