The association of anticonvulsant use with fractures in spinal cord injury.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Carbone, L; Chin, AS; Lee, TA; Burns, SP; Svircev, JN; Hoenig, H; Akhigbe, T; Thomas, F; Bailey, L; Weaver, F

Published Date

  • December 2013

Published In

Volume / Issue

  • 92 / 12

Start / End Page

  • 1037 - 1046

PubMed ID

  • 24252933

Pubmed Central ID

  • 24252933

Electronic International Standard Serial Number (EISSN)

  • 1537-7385

International Standard Serial Number (ISSN)

  • 0894-9115

Digital Object Identifier (DOI)

  • 10.1097/phm.0000000000000014

Language

  • eng