title: Risk of extremity fractures in adult outpatients with epilepsy.
abstract: OBJECTIVE
  To study the incidence of extremity fractures in a group of adult patients with epilepsy attending an outpatient clinic compared with the incidence of fractures in the general population in the same geographic area.
  
  
  METHODS
  We selected 177 consecutive adult patients with epilepsy attending the outpatient clinic at the Department of Neurology at Karolinska Hospital in Stockholm in 1995. This study population was matched with an Injury Registry to identify those epilepsy patients who during 1991 through 1995 attended the emergency department for an extremity fracture. The observed number of fractures in the epilepsy group was compared with the corresponding number of expected cases based on regional fracture rates. Relative-risk estimates for fractures were calculated with respect to the duration of epilepsy, mono- or polytherapy, and history of tonic-clonic seizures.
  
  
  RESULTS
  Twenty (11%) of 177 patients sustained 23 fractures that prompted a visit to the emergency department. The incidence of fractures in the epilepsy patients was 23.8/1,000 person-years. The overall Standardized Morbidity Ratio (SMR) was 2.39 (95% CI, 1.52-3.59). A significantly higher risk for fractures was thus found in patients with epilepsy. Risk factors were age 45 years or older, male sex, and occurrence of generalized seizures. It also was found that the relative risk of fractures was higher during the first and second year compared with >or=5 years after diagnosis (RR, 3.71; 95% CI, 1.20-11.48).
  
  
  CONCLUSIONS
  Our results highlight the risk of fractures in outpatients with epilepsy. In this patient group, 43% of the fractures were definitely or possibly seizure related. Males 45 years or older are a particular risk group. Special attention is required for this group of patients who are at higher risk for fractures. The risk is apparently higher in the first 2 years after diagnosis, although potential bias in ascertainment of fracture incidents in our study may have underestimated the long-term risk for fractures.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. hakan.persson@ks.se
authors.forename: Hakan B I
authors.initials: HB
authors.lastname: Persson
authors.forename: K A
authors.initials: KA
authors.lastname: Alberts
authors.forename: B Y
authors.initials: BY
authors.lastname: Farahmand
authors.forename: T
authors.initials: T
authors.lastname: Tomson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D005121:Extremities / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants