Antiepileptic drugs (AEDs) are used increasingly in clinical practice to treat a number of conditions. However, the relationship between the use of these medications, particularly the newer AEDs, and fracture risk has not been well characterized. We used data from the Women's Health Initiative (WHI) to determine the relationship bewteen the use of AEDs and falls, fractures, and bone mineral density (BMD) over an average of 7.7 years of follow-up. We included 138,667 women (1,385 users of AEDs and 137,282 nonusers) aged 50 to 79 years in this longitudinal cohort analyses. After adjustment for covariates, use of AEDs was positively associated with total fractures [hazard ratio (HR) = 1.44, 95% confidence interval (CI) 1.30–1.61], all site-specific fractures including the hip (HR = 1.51, 95% CI 1.05–2.17), clinical vertebral fractures (HR = 1.60, 95% CI 1.20–2.12), lower arm or wrist fractures (HR = 1.40, 95% CI 1.11–1.76), and other clinical fractures (HR = 1.46, 95% CI 1.29–1.65) and two or more falls (HR = 1.62, 95% CI 1.50–1.74) but not with baseline BMD or changes in BMD (p ≥ .064 for all sites). Use of more than one and use of enzyme-inducing AEDs were significantly associated with total fractures (HR = 1.55, 95% CI 1.15–2.09 and HR = 1.36, 95% CI 1.09–1.69, respectively). We conclude that in clinical practice, postmenopausal women who use AEDs should be considered at increased risk for fracture, and attention to fall prevention may be particularly important in these women. © 2010 American Society for Bone and Mineral Research.

Purpose-To evaluate any association between incidence of osteoporotic fractures and use of depot medroxyprogesterone acetate (DMPA) and/or anti-epileptic drugs (AEDs) among women and girls with developmental disabilities.Methods-Cross-sectional population-based observational study of all non-institutionalized females with developmental disabilities age thirteen and older who received fee-for-service Medicaid in Washington State during 2002 (N=6773), using administrative data.Main Findings-In a sample of 6,773 females, 140 women (2%) had an osteoporotic fracture during 2002. Among 340 users of DMPA, 13 (3.8%) had an osteoporotic fracture with an odds ratio of 2.4 (CI 95%, 1.3-4.4) for fracture compared to non-users. Among 1909 users of AEDs, 60 (3.1%) had an osteoporotic fracture with an odds ratio of 1.9 (CI 95%, 1.3-2.6) for fracture compared to non-users. We controlled for age and race (as Caucasian or non-Caucasian).Conclusions-Use of either AEDs or DMPA by women with developmental disabilities is associated with significantly increased incidence of fracture. Women and girls who have developmental disabilities may be poor candidates for DMPA use due to increased risk of fractures. Further research is indicated (1) to determine the specific risks profile of DMPA for this population, (2) to explore alternative means of managing significant menstrual problems and contraceptive needs in this population and (3) to screen current and previous users of DMPA and chronic users of AEDs for osteoporosis risk, regardless of age.Correspondence to: Kathleen C. Watson, watsonkc@u.washington.edu. Support for this study was provided by NINR NIH 5 T32 NR07106-07 and by NINR NIH P30 NR04001.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. People who have developmental disabilities (DD) are at increased risk of fractures due to cooccurrence of low BMD (Aspray et al. 1998;Jaffe, Timell, & Gulanski, 2001;Lohiya, TanFigueroa, & Iannucci, 2004) and increased incidence of falls and other trauma (Hsieh, Heller & Miller, 2001). Developmental disabilities are severe and chronic disabilities which begin before age 22 and are the result of mental retardation, cerebral palsy, epilepsy, autism or a similar condition (U.S. code Title 42, chapter 75, section 6001.5.1, 1992). They include a wide range of both physical and cognitive disabilities and many have associated health problems. NIH Public AccessDocumented risks for low BMD include limited mobility (Lohiya et al. 2004;Tyler, Snyder & Zyzanski, 2000;Jaffe, Timell, Elolia & Thatcher, 2005), use of anti-epileptic drugs (AEDs) (Ray, Papaioan...

The purpose of this grounded theory study is to develop a beginning substantive theory that explains the communication process between parents of children receiving center-based services for developmental delays and disabilities and the professional providers of those services. Communication is defined broadly as including both content and relationship dimensions. Twenty parents and 14 providers described their experience of communication with one another. The core phenomenon constructed from the data was striving for therapeutic relationships within a context of uncertainty. Both parents and providers operated in a context of uncertainty regarding the child and his or her development and prospects for the future as well as their expectations of each other. Both parents and providers used strategiesof balancing, reading the cues, questioning, managing uncertainty, and managing the sessions. The outcomes were relationships that were valued by the extent to which they were perceived as therapeutic to parents and child.

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