Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy

Abstract

Objective: The objective of this propensity score-matched, observational cohort study was to determine the effectiveness of osteoporosis medication on reducing the risk of non-trauma fracture (NTFx) among adults with epilepsy. Methods: Data from 01/01/2012 to 09/30/2015 was extracted from Optum Clinformatics Data Mart. NTFx risk attenuation from 12 months prior to 12 months after the individual's index date was examined for each group of adults ≥50 years of age as risk ratios (RRs with 95% confidence intervals [CIs]). Groups were stratified based on: (1) epilepsy status, as with vs without epilepsy (EP); and (2) if and when osteoporosis medication was first prescribed, as new users (treatment naive), consistent users (osteoporosis medication prescribed in pre-index period), and no users. Comparison groups were matched 1:1 to EP new users (n = 828/group) for demographics, glucocorticoid and antiseizure medication, and the Elixhauser comorbidity index. Difference-indifference analysis compared the change in pre-to post-index NTFx risk among groups as the ratio of the RR (RRR). Results: The pre-to post-index NTFx risk at any site was reduced for EP new users

Incidence of clinical fractures: A 7-year follow-up study in institutionalized adults with epilepsy and intellectual disability

“…To our knowledge, there are only few studies describing the efficacy of anti-osteoporosis treatment in patients on antiseizure drugs [31][32][33]. Lazzari et al (2013) performed a randomized controlled trial in male veterans with epilepsy [31].…”

“…Lacking a control group, it is unclear whether anti-osteoporosis treatment influenced the incidence of MOFs. Whitney (2020) adjusted for anti-osteoporosis treatment, by comparing five matched groups (n = 828 per group) by epilepsy status (with or without) and use of osteoporosis medication (no user, consistent user, or new user) [33]. His-study showed a twelve-month (non-traumatic) fracture risk attenuation in adults with epilepsy who were treated with anti-osteoporosis medication, especially in those who just started treatment.…”

Effect of levetiracetam and oxcarbazepine on 4‐year fragility fracture risk among prepubertal and pubertal children with epilepsy

“…Therefore, LEV had its own matched group (LEV matched ) and OXC had its own matched group (OXC matched ), pulling from the same comparator group (i.e., non‐ASM‐users without epilepsy). Propensity scores were computed based on age, sex, race/ethnicity, US region of residence, motor impairment, and baseline fracture using the PSMATCH procedure in SAS 9.4 (SAS Institute), as described previously 12,19 . The groups were each matched 1:2 (case:control) in a random fashion using a standard caliper of .25 standard deviations or less, without losing any participants from the LEV or OXC groups to limit bias.…”

“…Propensity scores were computed based on age, sex, race/ethnicity, US region of residence, motor impairment, and baseline fracture using the PSMATCH procedure in SAS 9.4 (SAS Institute), as described previously. 12,19 The groups were each matched 1:2 (case:control) in a random fashion using a standard caliper of .25 standard deviations or less, without losing any participants from the LEV or OXC groups to limit bias. Balance in matching was assessed using a standardized mean difference of .10 or less and compared using the chi-squared test for categorical variables or the independent t-test for continuous variables to ensure balance in matching.…”

Medizin für Menschen mit Behinderungen

“…Die Einleitung einer Abklärung und ggf. Therapie bei Verdacht auf Osteoporose ist im Sinne der Frakturprophylaxe sinnvoll [ 12 ].…”