The following is a summary of “Independent Associations of Incident Epilepsy and Enzyme-Inducing and Non–Enzyme-Inducing Antiseizure Medications With the Development of Osteoporosis,” published in the June 2023 issue of Neurology by Josephson et al.

Epilepsy and enzyme-inducing antiseizure medications (eiASMs) are linked to varying osteoporosis risks—Independent hazards quantified and modeled for incident cases. Researchers performed a retrospective study, spanning 1998 to 2019, with a median follow-up of 5 years, including 6,275 eligible patients from the Clinical Practice Research Datalink and hospital records. Inclusion criteria met by all patients (aged 18+). 

The outcomes were incident osteoporosis analyzed via models. Incident epilepsy as a time-varying covariate. Sub-analyses excluded BMI (30% missing), propensity score matching for eiASM receipt, restricted to incident onset epilepsy and restricted to epilepsy at age 65+. 

The results showed that among 8,095,441 adults, 6,275 had incident adult-onset epilepsy (3,220 female [51%] and 3,055 male [49%]; incidence rate, 62 per 100,000 person-years) with a median (IQR) age of 56 (38-73) years. Incident epilepsy was independently associated with a 41% faster time-to-incident osteoporosis (time ratio [TR], 0.59; 95% CI, 0.52-0.67; P< .001) when controlling for osteoporosis risk factors. Both eiASMs (TR, 0.91; 95% CI, 0.87-0.95; P<.001) and non-eiASMs (TR, 0.77; 95% CI, 0.76-0.78; P< .001) were associated with significantly increased risks independent of epilepsy, accounting for 9% and 23% faster times to development of osteoporosis, respectively. The associations remained consistent in the propensity score–matched analyses, cohorts restricted to adult-onset epilepsy, and cohorts limited to late-onset epilepsy.

They concluded epilepsy is linked to higher osteoporosis risk. Screening and prevention are recommended for all epilepsy patients.

Source: jamanetwork.com/journals/jamaneurology/article-abstract/2806001?resultClick=24