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).
Am J Phys Med Rehabil. 2013 Dec;92(12):1037-46; quiz 1047-50. doi: 10.1097/PHM.0000000000000014.
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.
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.
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.
Attention to fracture prevention is important when anticonvulsants are prescribed in spinal cord injury, particularly when more than one anticonvulsant is used.
本研究旨在确定抗癫痫药（包括苯二氮䓬类）是否与外伤性脊髓损伤男性患者下肢骨折风险增加相关。
纳入 2002 年至 2007 年期间退伍军人事务部脊髓疾病登记处有 2 年以上外伤性脊髓损伤史的所有男性患者。在此期间，确定了下肢骨折和抗癫痫药的使用情况。通过总体使用、药物类型（酶诱导型、非酶诱导型）、使用数量（单药治疗与多药治疗）、苯二氮䓬子类和使用的个体药物来确定抗癫痫药的使用与骨折之间的关联。
在该队列中，892 名退伍军人发生了骨折，6555 名退伍军人未发生骨折。与未使用抗癫痫药的患者相比，总体使用抗癫痫药（HR，1.17[95%CI，1.01-1.36]）、使用苯二氮䓬类药物（HR，1.28[95%CI，1.11-1.47]）以及多药治疗与单药治疗（HR，1.20[95%CI，1.00-1.42]）与骨折有显著正相关，但与抗癫痫药类型（HR，0.92[95%CI，0.58-1.47]）无关。替马西泮（HR，1.28[95%CI，1.01-1.62]）、阿普唑仑（HR，1.54[95%CI，1.04-2.29]）和地西泮（HR，1.23[95%CI，1.06-1.41]）与骨折显著正相关。
在脊髓损伤患者中开具抗癫痫药时，需要注意预防骨折，特别是在使用多种抗癫痫药时。
