Epileptic drugs and increased risk of fracture in people over 50
Epileptic drugs are used to cure or suppress epilepsy and seizures. Seizures are disruptions in brain activity that leads to behavioral change. It ranges from zoning for some seconds to convulsions, which may last for minutes and might cause injuries in case a person flails about. Most anti-epileptic drugs are said to induce non-traumatic fracture to people over 50 years. They are considered a secondary cause of osteoporosis because epilepsy is high associated with old people, a population already affected by osteoporosis (Cole, 2008). Moreover, these drugs are associated with bone density reduction especially to epileptic post-menopausal women.
Population-based studies have shown that older patients who take epileptic drugs are likely to suffer fractures in the wrist, vertebrae and hip. Researchers have linked 16,000 patients who have more than 50 years with bone fractures. They were prescribed clonazepam, Carbamazepine, gabapentin, phenytoin, as well as Phenobarbital and all portrayed high risk of non-traumatic fractures. According to Duffin (2011), the ratio ranged from 1.91 for phenytoin to 1.24 for clonazepam. Phenobarbital increased by 60%, Gabapentin by 49% and Carbamazepine by 81%. However, Valproate was not linked with a statistically significant increase in risk of fracture.
A pharmaco-epidemiological study exploring the relationship between non-traumatic fractures and AED use in people over 50 years was done extensively. The results showed that 15,792 patients had non-traumatic fractures between 1996 April to march 2004. These cases were compared among sex, age, ethnicity and ADGs number to 47,289 controls. Those with fractures were found to live in urban areas, have lower income and were said to use home care services as opposed to controls. The most common fracture site as show by this study was the wrist with 52%. This was followed by the hip with 26.2% and the vertebra with 21.7%. A significance increased risk of fracture in this study was associated with older adults. In the study, valproic acid was associated with fractures and those with fractures were less likely to suffer hypertension.
Since anti-epileptic medication does not prove to be effective due to its side-effects, other means ought to be encouraged. In my area of practice, such drugs should always be prescribed by qualified physicians or medical specialist. This will make sure that the right drug is administered to the right patient and prescribed effectively to reduce chances of side-effects. Surgical treatment should also be an option in cases where medication renders ineffective. This should be done by removing offending area of the brain, hemisphere or cutting the nerve connecting the two hemispheres, which are identified as being the source of epilepsy. Another treatment should be ketogenic diet, which is a special diet consisting of fat, sugar and protein. This method is very effective in controlling and even curing seizures (Bevan & O'Brien, 2011). Lastly, vagal nerve stimulation is another effective treatment of seizure. It involves the surgical placement of electrodes into the brain, which fires periodically to curb seizures from occurring.
Research findings have shown that anti-epileptic drugs increase the risk of fractures in older people. However, the information found was limited and this made it difficult to make conclusions. This proved that more research in this area is needed to establish evidence based results, which will relate epileptic drugs to fractures and reduction in bone density.
Bevan, R. & O'Brien, G. (2011). Recent advances in behavioural phenotypes as they affect adults. Advances in Mental Health and Intellectual Disabilities, 5, 5-14.
Cole, Z.A. (2008). Osteoporosis epidemiology update. CurrrRheumatol rep, 10, 92-96.
Duffin, C. (2011). Epilepsy drug fracture risk in over 55s. Archives of Neurology journal, 68, 107-112.