Neurology：抗癫痫药物或增跌倒及骨折风险

近日，《神经病学》（Neurology）杂志发表了澳大利亚和马来西亚联合进行的一项横断面研究成果，结果显示，服用抗癫痫药物（AED）的癫痫患者骨折风险升高，其中，较长期服用AED者的骨折风险最高。与不用AED的女性相比，服用AED女性的跌倒发生率较高。癫痫患者对其跌倒及骨折风险的知晓率不足30%。

研究纳入服用AED的癫痫患者150例及不服用AED的非癫痫者506名，收集其跌倒和骨折资料。

结果为：服用AED者于脊柱、锁骨和踝关节处的骨折率更高；骨质疏松症和骨折的发生率增加。

研究者估计，服用AED者每年骨折率将增加4%～6%；每10年任一部位的骨折率将增加40%，与癫痫发作相关的骨折率将增加60%。在使用AED治疗期间，与癫痫无关的骨折发生率高于与癫痫相关骨折发生率。

与不用AED的女性相比，服用AED女性发生非癫痫发作性跌倒（31%对17%，P=0.027）和多重跌倒（18%对5%，P=0.028）的次数更多。

doi:10.1212/WNL.0b013e31825f0466
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Falls and fractures in patients chronically treated with antiepileptic drugs

Baemisla Shiek Ahmad, MD, Keith David Hill, PhD, Terence John O'Brien, MD, Alexandra Gorelik, MSc, Natalie Habib, PhD and John Dennis Wark, PhD

Objective: To evaluate fractures and falls in epilepsy patients taking antiepileptic drugs (AED) and to assess their awareness of AED-related bone health, falls, and fracture risk. Methods: A cross-sectional study was conducted in epilepsy patients taking AEDs and in nonepileptic non-AED users. Information on falls and fracture history was collected. Results: A total of 150 AED users were compared with 506 non-AED users. Users had greater odds of fracture at spine (odds ratio [OR] 3.92; confidence interval [CI] 1.08–14.16; p = 0.037), clavicle (OR 3.75; CI 1.24–11.34; p = 0.019), and ankle sites (OR 2.34; CI 1.01–5.42; p = 0.048), increased odds for osteoporosis (OR 4.62; CI 1.40–15.30; p = 0.012), and fracture occasions (OR 2.64; CI 1.29–5.43; p = 0.008). We estimate that with every year of AED use the odds of fractures increase by 4%–6%, or 40% per decade for any fracture (OR 1.40; CI 1.02–1.91) and 60% for seizure-related fractures (OR 1.63; CI 1.10–2.37). Non-seizure-related fractures (69% of cumulative fractures) occurred more than seizure-related fractures during therapy. Female users, compared to female nonusers, had more non-seizure falls (31% vs 17%, p = 0.027) and multiple falls (18% vs 5%, p = 0.028) in the preceding year. Fewer than 30% of epilepsy patients knew of the association of AED use with increased risk for fractures, decreased bone mineral density, or falls. Conclusions: Epilepsy patients taking AEDs had a higher risk of fractures, which was highest in those with longer-term AED exposure. Female AED users had a higher prevalence of falls than matched nonusers. Awareness among epilepsy patients regarding risks of falling and fractures was low.