Fracture risk is increased in epilepsy

Objectives - To study fracture rates and risk factors for fractures in noni nstitutionalized patients with epilepsy. Material and methods - Historical follow-up. Self-administered questionnaires were issued to 755 patients wit h epilepsy (ICD 10: G40.0 to G40.9) and 1000 randomly selected controls fro m the background population. Results - A total of 345 patients (median age: 45, range 17-80 years) and 654 control subjects (median age: 43, range 19- 93 years) returned the questionnaire. Before epilepsy was diagnosed there w as no difference in overall fracture rate between patients and controls (RR = 1.0, 95% CI: 0.8-1.3). After the diagnosis the overall fracture rate was significantly higher in the patients (RR = 2.0, 95% CI: 1.6-2.5). Fracture s of the spine, forearms, femurs, lower legs, and feet and toes were signif icantly increased. Fractures related to seizures accounted for 33.9% (95% C I: 25.3-43.5%) of all fractures. After elimination of seizure related fract ures the increase in fracture frequency was only borderline significant: RR = 1.3 (95% CI: 1.0-1.7, P = 0.042). No difference in fracture energy betwe en patients and controls was observed (low energy fractures: 1.7/1.4%, medi um energy fractures: 59.8/52.0%, and high energy fractures: 38.3/46.6%). Us e of phenytoin (OR = 2.4, 95% CI: 1.1-5.4) and a family fracture history (O R = 2.4, 95% CI: 1.3-4.6) was associated with an increased fracture risk. C onclusions - Fractures were more common in epileptics than in controls espe cially among users of phenytoin. Most of the increase in fracture frequency was related to seizures and not to low bone biomechanical competence.