Pathological fractures in epilepsy

Fracture rates in epilepsy are two to three times that for the general population, although the influence of gender and age is not well defined. We examined, over a 7-year period at a single health care center, 750 patients with epilepsy who sustained the fractures. Among these patients, 293 (39%) had pathological fractures and 457 (61%) had traumatic/seizure-related fractures. Pathological fractures accounted for 71% of the 146 patients >60 years, a group traditionally at risk for pathological fractures (P < 0.02). Fractures in epilepsy are distributed with bimodal peaks in the fifth and eighth decades of life, although pathological fractures are a significant contributor across the life span, accounting for 20 to 40% of patients traditionally thought not to be at risk for involutional osteoporotic fractures. Together these findings suggest that epilepsy, and/or its treatment, is a dominant influence in the pathogenesis of fractures and may exacerbate the effects of aging-related involutional osteoporosis.