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Phenytoin, other antiepileptic drugs accelerate bone loss.(Gynecology)
BRECKENRIDGE, COLO. -- Antiepileptic drug usage by older women sharply increases their rate of bone mineral loss, with phenytoin being a particular offender, according to recent data from a landmark American study.
This is a disturbing finding in light of the fact that phenytoin remains the most frequently prescribed antiepileptic drug (AED) in this country, including among older patients, Jose F. Cavazos, M.D., said at a conference on epilepsy syndromes sponsored by the University of Texas at San Antonio.
"If you start a 70-year-old woman on phenytoin and her life expectancy is 15 years, you're going to considerably increase her likelihood of having a hip fracture, compared with women using other anticonvulsants," added Dr. Cavazos of the university's South Texas Comprehensive Epilepsy Center.
Dr. Cavazos noted that a fuller understanding of the scope of the fracture risk associated with specific AEDs was recently provided by an enormous population-based case-control study led by Peter Vestergaard, M.D., of Aarhus (Denmark) University. The investigators compared rates of AED use in 124,655 patients with any fracture and 373,962 controls.
In an unadjusted analysis, all AEDs--both traditional and newer ones--were associated with increased risk of fracture. However, after adjustment for history of corticosteroid use, prior fractures, diagnosis of epilepsy, comorbid conditions, and other potential confounders, the list of AEDs associated with a significantly increased fracture risk was narrowed to phenobarbital, with a 79% increased risk; clonazepam, 27%; carbamazepine, 18%; valproate, 15%; and oxcarbazepine, 14%.
While phenytoin and topiramate were associated with increased fracture rates of 20% and 39%, respectively, these didn't reach significance ...
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Source: HighBeam Research, Phenytoin, other antiepileptic drugs accelerate bone loss.(Gynecology)