Fracture Risk and Bone Health in Veterans Treated for Epilepsy (S53.003)

Objective: Complete an electronic medication use valuation within the VA Healthcare System (VAHCS) to determine the rate of fractures in veterans treated for epilepsy with AEDs. Background: Epilepsy patients treated with AEDs have a two to six times greater risk of fractures compared to the general population. The mechanism of fractures maybe multifactorial including exposure enzyme-inducing AED (EIAEDs) and vitamin D deficiency. Fractures are potentially preventable. Design/Methods: Using VHA national administrative and survey databases, veterans treated with AEDs for new onset epilepsy were identified. Demographic information (gender, age), AED classification (EIAED or non-enzyme inducing/NEIAED), fracture diagnosis, co-morbid medical problems, diagnostic tests were analyzed. Results: We identified veterans treated with one AED for new onset epilepsy within the VAHCS (FY10-FY15; N=37, 016). Over 92% were men, with a mean age>59. Among those who met criteria, 27% (n=10,115) received enzyme inducing AEDs (EIAEDs); 26,901 received non-enzyme inducing AEDs (NEIAEDs). Diagnosis of osteopenia/osteoporosis was present in 777 (7.68%) of those receiving EIEADs, and 1,600 (5.95%) receiving NEIAEDs. The prevalence of fractures after initiation of EIAED and NEIAED were 5.98% and 5.26% respectively. In both groups, Vitamin D levels drawn in VHA were checked in fewer than 22% and DXA scans were done in 5.4% (EIAEDs) and 3.14% (NEIAEDs). Vitamin D supplementation after initiation of EIAED and NEIAED were 8.93% and 5.80% respectively. Conclusions: Fracture rates and diagnoses of bone loss are high in treated veterans with new onset epilepsy. Surveillance practices for bone health monitoring are underutilized and treatment with Vitamin D may be under-prescribed. Based on this data, the VA will develop educational tools and programs to increase provider risk awareness. Future efforts will potentially include a safety project entailing a medication use evaluation tracker (MUET). Further research is needed to understand the underlying pathophysiology of fractures in persons with epilepsy. Disclosure: Dr. Van Cott has nothing to disclose. Dr. Adler has nothing to disclose. Dr. Tortorice has nothing to disclose. Dr. Pugh has nothing to disclose. Dr. Gidal has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Dr. Gidal has served as a consultant and speaker for Eisai, Sunovion, UCB, and Lundbeck, and as a consultant for Upsher-Smith. Dr. Dong has nothing to disclose. Dr. Cunningham has nothing to disclose.