SEATTLE—It has already been established that women with epilepsy have an increased chance of developing osteoporosis, but men with epilepsy may also be at risk for the bone disease, even at an early age, according to Robert Bonwetsch, MD. Along with coinvestigator Mercedes P. Jacobson, MD, Dr. Bonwetsch found that all men in their study had one thing in common—they had taken at least one of the older antiepileptic drugs that have been associated with decreased bone density.

“Men with epilepsy, and especially those with epilepsy since childhood, would benefit from early screening for osteoporosis, as well as supplementation of vitamin D and calcium to prevent osteoporosis,” Dr. Bonwetsch reported. “A lot of men have had epilepsy since their early childhood and have been taking antiepileptic drugs since before they had accumulated their peak bone mass.” Dr. Bonwetsch is affiliated with the Department of Neurology at the Medical College of Pennsylvania Hahnemann University in Philadelphia. He presented his findings at the 2002 Annual Meeting of the American Epilepsy Society.

Osteoporosis and the associated morbidity are a major burden on the economy, said Dr. Bonwetsch. Previously, postmenopausal Caucasian women have been recognized as being at risk for osteoporosis. More recently, women with epilepsy have been identified as being at even greater risk for this disease, partially because antiepileptic drugs have a negative effect on bone density. The risk for men in general and especially for men with epilepsy has not been well documented.

MEN, AEDs, AND OSTEOPOROSIS

Drs. Bonwetsch and Jacobson retrospectively analyzed data collected from 50 men with epilepsy, ages 18 to 71 with a mean age of 41. All patients were observed at the university’s epilepsy clinic and were interviewed regarding their calcium intake, exercise habits, and whether they had taken supplemental calcium and/or vitamin D. Overall, 15 primary and secondary risk factors for developing osteoporosis were evaluated.

The investigators found that in 74% of patients the onset of epilepsy occurred before age 25, which is the age at which bone mass is highest. Only 18% of the patients engaged in adequate exercise, and only 12% ingested the daily recommended calcium amount of 800 to 1,200 mg. An additional handicap prevented 34% from getting adequate exercise. Two patients were taking long-term corticosteroids—one for Rasmussen’s encephalitis and one for central nervous system sarcoid.

Of the 50 patients, 10% underwent a dexascan, which showed signs of osteopenia/osteoporosis in three patients. One man had a normal bone mass for his age, and one had increased bone density. Patients with decreased bone mass were ages 32, 47, and 52, and all had epilepsy since early childhood. Furthermore, 14% of all patients took calcium supplements; 4%, vitamin D; and 4%, alendronate. The only patients who took supplements were on chronic corticosteroids or had proven loss of bone mass.

“Epilepsy often seems to be associated with other comorbidities, preventing the patient from exercising sufficiently to prevent osteoporosis,” Dr. Bonwetsch noted. “Further studies of the effects of antiepileptic drugs, especially the newer ones, on bone metabolism are needed.”

NR