Abstract Details

Several AEDs used regularly by Epileptologists are associated with osteoporosis or osteopenia with chronic use. However, no national recommendations or guidelines are catered specifically for patients with epilepsy at risk for AED-induced bone loss.

To determine the clinical management variability for elderly patients with epilepsy who are at risk for anti-epileptic drug (AED)-induced bone loss.

A retrospective chart review from 8/1/2020 to 7/31/2021 was completed on outpatient service of four Epileptologists from St. Luke’s Neurology, Epilepsy Division. Total 118 patients aged 65-75 who were prescribed one of the following: carbamazepine, divalproex, phenobarbital, phenytoin, and primidone were analyzed. Data included age, sex, AED(s) taken, prophylactic measures known to improve bone health (Vitamin D, Calcium, Bisphosphonates, multivitamin), DEXA scan (yes/no), DEXA results (normal, osteoporosis or osteopenia) were collected. The data were analyzed with the Excel functions.

Of total 118 patients (62 males and 56 females), 31% males vs 43% females had osteoporosis/osteopenia. DEXA was ordered in 26% males vs 55% females. Prophylactic measures were on 73% males vs 66% females. Divalproex was prescribed the most (40% males vs 64% females). With divalproex, 9% females had osteoporosis and 16% had osteopenia, whereas it was 5% osteoporosis and 5% osteopenia for males. Prophylactic rate of patients without osteoporosis/osteopenia was 31%. DEXA order rate of patients without osteoporosis/osteopenia was 7%.

This preliminary data shed light on treatment differences of elderly epilepsy patients. Low prophylactic and DEXA rates likely are placing them at risk of AED-Induced bone loss. DEXA was ordered more for females than males. Fewer females were on prophylactic measures than males despite a higher frequency of osteoporosis/osteopenia. Identifying possible causes of this discrepancy warrants further research. Clear treatment guidelines at the national level may lead to standardization of the management of these patients and improved outcomes.