Osteoporosis medication yields survival benefits in epilepsy

Adult patients with epilepsy who are initiated on osteoporosis treatment appear to have a reduced 3-year risk of mortality, with bisphosphonates showing a unique protective effect compared with other drugs, according to a study.

Epilepsy patients are at risk of fragility fractures, and these can contribute to a faster rate of premature morbidity and mortality. In the present study, the researchers explored whether the improvements in health and survival associated with osteoporosis medication—possibly through better skeletal robustness—in the general population might be extended to epilepsy patients.

The researchers looked at a cohort of treatment-naïve patients aged ≥50 years who started osteoporosis medication (EP new users; n=733), patients who were not prescribed the medication (EP no users), and adults without epilepsy who initiated osteoporosis medication (non-EP new users; comparison groups combined: n=2,932). These groups were matched according to demographics, glucocorticoid and antiseizure medication, prior 12-month fracture, and the Elixhauser comorbidity index.

About 83 percent of EP new users were prescribed bisphosphonates. Results revealed that mortality in the EP new user group was lower than in the EP no user group (incidence rate ratio [IRR], 0.69, 95 percent confidence interval [CI], 0.52–0.93), but higher relative to the non-EP new user group (IRR, 1.42, 95 percent CI, 1.04–1.94).

On Cox proportional hazards regression, EP new users using bisphosphonates vs other medications had a lower risk of death (hazard ratio [HR], 0.56, 95 percent CI, 0.30–1.04), although the difference was marginally insignificant (p=0.066). On the other hand, this effect was not seen in the non-EP new user group (HR, 1.09, 95 percent CI, 0.72-1.65).