title: The association of anticonvulsant use with fractures in spinal cord injury.
abstract: OBJECTIVE
  The aim of this study was to determine whether anticonvulsants, including the benzodiazepine subclass, are associated with an increased risk for lower extremity fractures in male patients with spinal cord injury.
  
  
  METHODS
  All male patients with a history of a traumatic spinal cord injury of 2 yrs' duration or longer in the Veterans Affairs Spinal Cord Disease Registry from 2002 to 2007 were included. Incident lower extremity fractures during this period and anticonvulsant use were identified. The association of anticonvulsant use, overall, by type (enzyme inducing, non-enzyme inducing), by number (monotherapy vs. polytherapy), by benzodiazepine subclass, and by individual medication used was determined.
  
  
  RESULTS
  In this cohort, 892 veterans sustained a fracture, and 6555 did not. Compared with nonusers of anticonvulsants, there was a significant positive relationship with fractures by overall use of anticonvulsants (HR, 1.17 [95% CI, 1.01-1.36]), by users of the benzodiazepine subclass (HR, 1.28 [95% CI, 1.11-1.47]), and by polytherapy compared with monotherapy (HR, 1.20 [95% CI, 1.00-1.42]) but not by anticonvulsant type (HR, 0.92 [95% CI, 0.58-1.47]). Temazepam (HR, 1.28 [95% CI, 1.01-1.62]), alprazolam (HR, 1.54 [95% CI, 1.04-2.29]), and diazepam (HR, 1.23 [95% CI, 1.06-1.41]) were significantly positively associated with fractures.
  
  
  CONCLUSIONS
  Attention to fracture prevention is important when anticonvulsants are prescribed in spinal cord injury, particularly when more than one anticonvulsant is used.
authors.affiliation: From the Department of Veterans Affairs Medical Center, Memphis, Tennessee (LC, TA); Department of Medicine, University of Tennessee Health Science Center, Memphis (LC, TA); Edward J. Hines, Jr. VA Hospital, Hines, Illinois (ASC, TAL, LB, FW); University of Illinois at Chicago (TAL); VA Puget Sound Health Care System, Seattle, Washington (SPB, JNS); Department of Rehabilitation Medicine, University of Washington, Seattle (SPB, JNS); Durham VAMC, North Carolina (HH); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (FT); and Stritch School of Medicine, Loyola University, Maywood, Illinois (FW).
authors.forename: Laura
authors.initials: L
authors.lastname: Carbone
authors.forename: Amy S
authors.initials: AS
authors.lastname: Chin
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
authors.forename: Jelena N
authors.initials: JN
authors.lastname: Svircev
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
authors.forename: Titilola
authors.initials: T
authors.lastname: Akhigbe
authors.forename: Fridtjof
authors.initials: F
authors.lastname: Thomas
authors.forename: Lauren
authors.initials: L
authors.lastname: Bailey
authors.forename: Frances
authors.initials: F
authors.lastname: Weaver
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects; D050723:Fractures, Bone / Q000139:chemically induced*; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries; D014728:Veterans
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines