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BONE DISEASE IN EPILEPSY: THE FORGOTTEN SIDE EFFECT
  1. Robert Hurford,
  2. Rajiv Mohanraj
  1. Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust; University of Manchester

    Abstract

    Introduction Patients with epilepsy are at 2–6 times higher risk of bone fractures compared to the general population (Salvheim, 2011). The explanation for this is multifactorial, including seizure–related trauma, reduced physical activity and the osteopenic effect of antiepileptic drugs (AEDs) (Pack, 2008). We set out to audit the compliance with local guidelines stipulating annual bone profile assessments in patients taking AEDs.

    Methods Inclusion criteria consisted of patients who were a) taking AEDs and attended appropriate epilepsy clinics between 1st January and 31st December 2012, and b) are a resident of Salford. Attendances at clinic 6 months before and after the introduction of local guidelines in July 2012 were compared. The proportion of bone profiles and DEXA scans conducted, the prevalence of osteoporosis and bone fractures and proportion of those treated for Vitamin D deficiency between these two groups were compared.

    Results 228 patients were included in the audit. There was a significant difference in the proportion of those with calcium/ phosphate levels (29.9% to 50.0%, proportion difference 20.1%; 95% CI 9.6–30.2% [p=0.0001]) and vitamin D levels (1.7% to 19.4%, proportion difference 17.7%; 95% CI 11.7–24.7% [p<0.0001]) before and after the local policy introduction. Of the 33 patients with available Vitamin D levels, 15 (45%) were Vitamin D deficient, of which 10 (66.6%) were not being treated. A diagnosis of osteoporosis was documented in 8 patients (3.5%). Of the 39 (17.1%) patients with documented bone fractures, 20 (51.3%) had no bone profile conducted and 18 (38.3%) of the fractures were considered osteopenic. No DEXA scans were conducted in this cohort.

    Conclusions there was a significant difference in the rate of bone profiling in epilepsy patients before and after the local policy introduction with a trend of improvement, but compliance still falls below the target of 90%. There is a high rate of bone fractures and osteoporosis in these patients which is in keeping with current knowledge and supports annual bone assessments in these patients. DEXA scans should be considered in those with multiple risk factors and bone fractures. Increased awareness of this policy requirement, education of junior members of staff and speciality nurses, and re–auditing is recommended to improve and monitor compliance.

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