Vestergaard P, Tigaran S, Rejnmark L, Tigaran C, Dam M, Mosekilde L
Department of Endocrinology and Metabolism, Aarhus Amtssygehus, Aarhus University Hospital, Denmark.
Acta Neurol Scand. 1999 May;99(5):269-75. doi: 10.1111/j.1600-0404.1999.tb00675.x.
To study fracture rates and risk factors for fractures in non-institutionalized patients with epilepsy.
Historical follow-up. Self-administered questionnaires were issued to 755 patients with epilepsy (ICD 10: G40.0 to G40.9) and 1000 randomly selected controls from the background population.
A total of 345 patients (median age: 45, range 17-80 years) and 654 control subjects (median age: 43, range 19-93 years) returned the questionnaire. Before epilepsy was diagnosed there was no difference in overall fracture rate between patients and controls (RR = 1.0, 95% CI: 0.8-1.3). After the diagnosis the overall fracture rate was significantly higher in the patients (RR = 2.0, 95% CI: 1.6-2.5). Fractures of the spine, forearms, femurs, lower legs, and feet and toes were significantly increased. Fractures related to seizures accounted for 33.9% (95% CI: 25.3-43.5%) of all fractures. After elimination of seizure related fractures the increase in fracture frequency was only borderline significant: RR = 1.3 (95% CI: 1.0-1.7, P = 0.042). No difference in fracture energy between patients and controls was observed (low energy fractures: 1.7/1.4%, medium energy fractures: 59.8/52.0%, and high energy fractures: 38.3/46.6%). Use of phenytoin (OR = 2.4, 95% CI: 1.1-5.4) and a family fracture history (OR = 2.4, 95% CI: 1.3-4.6) was associated with an increased fracture risk.
Fractures were more common in epileptics than in controls especially among users of phenytoin. Most of the increase in fracture frequency was related to seizures and not to low bone biomechanical competence.
研究非住院癫痫患者的骨折发生率及骨折危险因素。
历史随访。向755例癫痫患者（国际疾病分类第10版：G40.0至G40.9）及从背景人群中随机选取的1000名对照者发放自填式问卷。
共345例患者（中位年龄：45岁，范围17 - 80岁）和654名对照者（中位年龄：43岁，范围19 - 93岁）返回了问卷。在癫痫诊断之前，患者和对照者的总体骨折发生率无差异（相对危险度=1.0，95%可信区间：0.8 - 1.3）。诊断之后，患者的总体骨折发生率显著更高（相对危险度=2.0，95%可信区间：1.6 - 2.5）。脊柱、前臂、股骨、小腿以及足和趾的骨折显著增加。与癫痫发作相关的骨折占所有骨折的33.9%（95%可信区间：25.3 - 43.5%）。排除与癫痫发作相关的骨折后，骨折频率的增加仅为临界显著：相对危险度=1.3（95%可信区间：1.0 - 1.7，P = 0.042）。未观察到患者和对照者之间骨折能量的差异（低能量骨折：1.7/1.4%，中等能量骨折：59.8/52.0%，高能量骨折：38.3/46.6%）。使用苯妥英（比值比=2.4，95%可信区间：1.1 - 5.4）和家族骨折病史（比值比=2.4，95%可信区间：1.3 - 4.6）与骨折风险增加相关。
癫痫患者的骨折比对照者更常见，尤其是在使用苯妥英的患者中。骨折频率增加的大部分与癫痫发作有关，而非与低骨生物力学能力有关。
