New Study: Antiepileptic Drugs Increase Risk of Fracture

Epilepsy affects 65 million people worldwide.

The most commonly used antiepileptic drugs (AED) to treat epilepsy have varying success rates; some as low as 50%.⁽¹⁾ On top of that, evidence⁽²⁾ has emerged that antiepileptic drugs increase fracture risk – irrespective of vitamin D levels. ⁽³⁾

Many theories of AED-associated bone loss and the mechanism involved have been proposed. But as of yet no single theory explains all the reported findings.

Epilepsy occurs mostly among the very young and the very old, although it can strike at any age. It affects more than 300,000 children under the age of 15 in the U.S. – over 90,000 of whom have seizures that can’t be treated adequately.

570,000 American adults over the age of 65 have epilepsy. It is the fourth most common neurological disorder, after stroke, migraine, and Alzheimer’s disease.

A January 2011 Canadian study looked at 15 792 people who had suffered fractures of the wrist, hip, and vertebra occurring between 1996 and 2004 and had evidence of prior AED use. The results from this huge group were “a significant increase in fracture risk was found for most of the AEDs being investigated”. ⁽⁴⁾

Furthermore, a 2008 study published in Epilepsy Currents examined bone mineral density (BMD) by dual-energy x-ray absorptiometry (DEXA) in 81 men, between ages 25 and 54 years and found ‘Long-term AED therapy in young male patients who have seizures causes significant bone loss at the hip in the absence of vitamin D deficiency.’⁽⁵⁾

It’s believed that AEDs impact osteoblasts (the cells responsible for bone growth), directly impair calcium absorption, elevate homocysteine, inhibit response to parathyroid hormone, hyperparathyroidism, reduce reproductive sex hormones, and reduce vitamin K level.

The connection to calcium absorption and bone health is well known. However the importance of vitamin K to bone mineral density is less so. Vitamin K studies have demonstrated that it not only increases bone mineral density in people with osteoporosis, but can also actually reduce fracture rates. ⁽⁶⁾ Vitamin K also positively affects calcium balance, so the deficiency of it must be addressed and compensated for with long term AED users.

Identifying bone density with DEXA testing and taking any steps to counter further loss is especially important for the large number of sufferers of epilepsy who do not respond to AEDs. Because their risk of sustaining a fracture is especially high during a seizure it is crucial to take steps to increase bone strength and density.

Regular weight bearing exercises, optimal amounts of fresh mineral and vitamin rich foods are the building blocks that can positively affect bone development and strength for AED users.

However, data shows large portions of western populations as vitamin and mineral deficient due to changes in farming methods, and eating patterns, along with other socio/economic reasons. For this reason, high quality vitamin and mineral supplements are often recommended by experts.

New human studies show plant-based calcium supplements can help increase bone density, which could help reduce risk of fracture for AED users.⁽⁷⁾

SOURCES:

1. http://www.epilepsyfoundation.org/aboutepilepsy/treatment/medications/index.cfm
2. http://www.ncbi.nlm.nih.gov/pubmed/15184613
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC321050/
4. http://archneur.jamanetwork.com/article.aspx?articleid=802096
5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC321050/#!po=83.3333
6. http://www.ncbi.nlm.nih.gov/pubmed/11684396
7. https://www.algaecal.com/research/