Anticonvulsant use and bone health in a population-based study of men and women: cross-sectional data from the Geelong Osteoporosis Study

Vinoomika Chandrasekaran,Sharon L Brennan-Olsen,Lana J Williams,Amanda L Stuart,Jason M Hodge,Michael Berk,Julie A Pasco,Rasika M Samarasinghe

doi:10.1186/s12891-021-04042-w

Abstract

BackgroundAnticonvulsant use has been linked to bone deficits in specific patient populations. We studied the association between anticonvulsant use and bone health in a population-based sample of men and women.MethodsData from 926 men (24-73 yr) and 1070 women (21-94 yr) participating in the Geelong Osteoporosis Study were included. Bone mineral density (BMD, g/cm2) of the PA-spine and total hip was measured using dual-energy X-ray absorptiometry (Lunar). Bone quality was determined using quantitative heel ultrasound (QUS). Anthropometry was conducted and socioeconomic status was determined. Medication and lifestyle information was obtained via questionnaire. Linear regression was used to test associations between anticonvulsant use and bone health before and after adjustment for potential confounders.ResultsSeventeen (1.8%) men and 20 (1.9%) women reported anticonvulsant use. In men, anticonvulsant users had 9.1% lower adjusted mean BMD at the spine and hip compared to non-users. Body mass index was an effect modifier at the spine. Anticonvulsant users also had 1.8% lower speed of sound (SOS), 10.6% lower broadband ultrasound attenuation (BUA) and 13.7% lower stiffness index (SI) compared to non-users. In women, BMD tended to be lower at the hip compared to non-users as with the bone quality measure, BUA. No significant associations were observed at the spine or the other bone quality measures, SOS and SI.ConclusionOur data suggest that bone quantity and quality, assessed using BMD and QUS, are lower for men and possibly women who use anticonvulsants. While further exploration into potential mechanisms is needed, our findings suggest that monitoring bone health among users of anticonvulsants is warranted.

Highlights

Anticonvulsant use has been linked to bone deficits in specific patient populations
Participants This study utilised data from men and women participating in the Geelong Osteoporosis Study (GOS), a large, ongoing, population-based study conducted in the Barwon Statistical Division in south-eastern Australia [21]
Anticonvulsant users were older, less active, consumed less alcohol and were more likely to have a previous adult fracture than non-users; otherwise the groups were similar in regard to Body mass index (BMI), smoking status, calcium intake, osteoporosis status and socio-economic status (SES) (Table 1)

Summary

Introduction

We studied the association between anticonvulsant use and bone health in a population-based sample of men and women. The lifetime risk of developing an osteoporotic fracture in industrialised nations is 40–56% for women and 20–30% for men above the age of 50 years [3]. Among those aged 50 years and over, the prevalence of osteoporosis or low bone mass is estimated to increase by 31% between 2012 and 2022 [4]. Being a 2-dimensional measure, BMD does not sufficiently explain variance in fracture outcomes amongst individuals with similar BMD measures [6], additional bone measures may be useful. Trabecular bone in sites such as the vertebral body and the calcaneus is more susceptible to the effects of altered metabolism [8]

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