Hsin-Hsuan Cheng1, Wei-Chun Huang2,3,4, Shaw-Yeu Jeng5. 1. a Department of Pharmacy , Taichung Veterans General Hospital , Taichung , Taiwan. 2. b Critical care center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan. 3. c Department of Physical Therapy , Fooyin University , Kaohsiung , Taiwan. 4. d School of Medicine , National Yang-Ming University , Taipei , Taiwan. 5. e Division of Urology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.
Abstract
OBJECTIVE: Although classic anti-epileptic drugs have been associated with increased fracture risk, data are lacking on the outcomes of newer anti-epileptic drugs, such as gabapentin (GBP), levetiracetam, pregabalin, oxcarbazepine (OXC), and topiramate. This study was designed to determine fracture risks in the elderly associated with newly-developed anti-epileptic drugs. METHODS: A total of 2,169 patients (median age = 71.01 years, SD = 11.25 years) who experienced fractures between 2006 and 2013 were selected. For each case, age-, sex-, and comorbidity-matched controls were selected. The assessed clinical outcome was any fracture, and the use of anti-epileptic drugs was used as an exposure variable. RESULTS: There were no differences in age, sex, or comorbidities between patients and controls, but patients with fractures often lived in urban areas (odds ratio [OR] = 1.17; 95% confidence interval [CI] = 1.05-1.29) and had low income (OR = 1.14; 95% CI = 1.01-1.29) compared to controls. A significant increase in fractures was associated with OXC (OR = 3.31; 95% CI = 1.59-6.92), carbamazepine (CBZ; OR = 2.18; 95% CI = 1.31-3.61), and GBP (OR = 1.79; 95% CI = 1.01-3.18). Phenobarbital (OR = 1.97; 95%CI = 0.53-7.34), phenytoin (OR = 0.52; 95% CI = 0.23-1.16), levetiracetam (OR = 1.84; 95% CI = 0.55-6.16), valproic acid (OR = 1.01; 95% CI = 0.53-1.92), lamotrigine (OR = 1.44; 95% CI = 0.12-16.65), and topiramate (OR = 0.47; 95% CI = 0.10-2.31) were not associated with fracture risk. CONCLUSIONS: CBZ, GBP, and OXC users have a significantly higher risk of fracture. Most recently-developed anti-epileptic drugs are not associated with an increased risk of fracture in individuals aged ≥50 years.
OBJECTIVE: Although classic anti-epileptic drugs have been associated with increased fracture risk, data are lacking on the outcomes of newer anti-epileptic drugs, such as gabapentin (GBP), levetiracetam, pregabalin, oxcarbazepine (OXC), and topiramate. This study was designed to determine fracture risks in the elderly associated with newly-developed anti-epileptic drugs. METHODS: A total of 2,169 patients (median age = 71.01 years, SD = 11.25 years) who experienced fractures between 2006 and 2013 were selected. For each case, age-, sex-, and comorbidity-matched controls were selected. The assessed clinical outcome was any fracture, and the use of anti-epileptic drugs was used as an exposure variable. RESULTS: There were no differences in age, sex, or comorbidities between patients and controls, but patients with fractures often lived in urban areas (odds ratio [OR] = 1.17; 95% confidence interval [CI] = 1.05-1.29) and had low income (OR = 1.14; 95% CI = 1.01-1.29) compared to controls. A significant increase in fractures was associated with OXC (OR = 3.31; 95% CI = 1.59-6.92), carbamazepine (CBZ; OR = 2.18; 95% CI = 1.31-3.61), and GBP (OR = 1.79; 95% CI = 1.01-3.18). Phenobarbital (OR = 1.97; 95%CI = 0.53-7.34), phenytoin (OR = 0.52; 95% CI = 0.23-1.16), levetiracetam (OR = 1.84; 95% CI = 0.55-6.16), valproic acid (OR = 1.01; 95% CI = 0.53-1.92), lamotrigine (OR = 1.44; 95% CI = 0.12-16.65), and topiramate (OR = 0.47; 95% CI = 0.10-2.31) were not associated with fracture risk. CONCLUSIONS:CBZ, GBP, and OXC users have a significantly higher risk of fracture. Most recently-developed anti-epileptic drugs are not associated with an increased risk of fracture in individuals aged ≥50 years.
Authors: Vinoomika Chandrasekaran; Amanda L Stuart; Julie A Pasco; Sharon L Brennan-Olsen; Michael Berk; Jason M Hodge; Rasika M Samarasinghe; Lana J Williams Journal: J Musculoskelet Neuronal Interact Date: 2021-09-01 Impact factor: 2.041