Metabolic bone disease in patients with epilepsy and the use of antiepileptic drugs-Insight from a Danish cross-sectional study
Metabolic bone disease in patients with epilepsy and the use of antiepileptic drugs-Insight from a Danish cross-sectional study
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DOI：
10.1016/j.seizure.2021.01.008
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发表时间：
2021-03-01
影响因子：
3
通讯作者：
Diemar, Sarah Seberg
中科院分区：
文献类型：
--
作者：
Baddoo, Daniel Roger;Mills, Alexander Andrew;Diemar, Sarah Seberg
背景：骨质疏松症是一种以骨矿物质密度（BMD）降低为特征的骨疾病，可导致骨折风险增加。癫痫患者更容易发生骨折。考虑到癫痫相关骨折，癫痫患者人群的骨折风险仍然增加。这可以归因于抗癫痫药物（AEDs）的不良反应。目的：本研究的目的是调查在丹麦癫痫患者中使用AEDs和BMD降低之间的关联。方法：该研究是一项横断面研究，基于从丹麦Glostrup癫痫门诊就诊的835名患者中检索的数据，从2006年1月1日至2018年1月31日。这些数据包括DXA扫描结果和人口统计信息。结果：服用EIAEDs组发生骨质疏松的危险性是服用NEIAEDs组的2.2倍（95%CI：1.2-3.8，P = 0.007）。此外，患骨质疏松症的几率随着癫痫持续时间的增加而增加（OR = 1.0，95% CI：1.0-1.0，P = 0.001），当患者服用两种AED时，与服用一种AED相比（OR = 2.3，95% CI：1.3-4.1，P < 0.001）。此外，与服用一种AED相比，服用三种AED导致骨质疏松症的风险高2.3倍（95% CI：1.2-4.4，P = 0.01）。结论：在多种危险因素的影响下，EIAED、AEDs的综合治疗及癫痫病程与骨质疏松症的发生有关。有必要使用这些已知的危险因素作为指南，以确定患者发生骨质疏松症的风险增加。
Background: Osteoporosis is a bone disorder defined by a decrease in bone mineral density (BMD) which can lead to an increased risk of fractures. Patients with epilepsy are more prone to having fractures. When accounting for seizure-related fractures, the epilepsy patient population still suffers from an increased risk of fractures. This can be attributed to adverse effects of antiepileptic drugs (AEDs).Aim: The aim of this study was to investigate the association between the use of AEDs and decreased BMD in a large unselected population of Danish patients with epilepsy.Method: The study was a cross-sectional study based on data retrieved from 835 patients visiting an outpatient Epilepsy Clinic in Glostrup, Denmark, from January 1st 2006 -January 31st 2018. The data included results from DXA-scans and demographic information. Logistic regression models and other statistical analyses were performed.Results: The results showed that the odds for having osteoporosis when taking EIAEDs were 2.2 (95 % CI: 1.2-3.8, P = 0.007) times higher than those taking NEIAEDs. Furthermore, the odds for having osteoporosis increased with duration of epilepsy (OR = 1.0, 95 % CI: 1.0-1.0, P = 0.001) and when the patients consume two AEDs compared to one AED (OR = 2.3, 95 % CI: 1.3-4.1, P < 0.001). Additionally, consuming three AEDs compared to one lead to a 2.3 times higher risk of having osteoporosis (95 % CI: 1.2-4.4, P = 0.01). Conclusion: When accounted for many riskfactors, EIAEDs, polytherapy with AEDs and duration of epilepsy are correlated with osteoporosis. There is a need for using these known riskfactors as guidelines in indentifying patients at increased risk of developing osteoporosis.