Fracture risk with antiepileptic drugs

Fracture risk with antiepileptic drugs

Most antiepileptic drugs (AEDs) are associated with an increased risk of nontraumatic fracture according to a retrospective match cohort study. Nearly 16,000 patients with a history of prior AED use (carphenazine, clonazepam, ethosuximide, felbamate, gabapentin, lamotrogine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, primidone, topiramate, valproic acid, or vigabatrin) were compared to up to three matched controls each. Rates of fractures of the wrist, hip, and vertebrae were measured between 1996 and 2004. A significant increase in fracture risk was found for most AEDs, with an adjusted odds ratio of 1.24 for clonazepam to 1.91 for phenytoin. The only AED not associated with increased fracture risk was valproic acid.

The authors concluded that most AEDs are associated with an increased risk of nontraumatic fractures in individuals age 50 or older. They suggested that the risk of fracture with newer AEDs needs to be determined, as well as the effect of bone protective medications in this population (Arch Neurol 2011;68:107-112). The mechanism of increased fracture risk in patients using AEDs is unknown, but may be related to accelerated vitamin D catabolism, calcium absorption, or an effect on osteoblasts.