Do anti-epileptic drugs, regardless of the treatment indication, predict an increased risk in the incidence of falls and fractures?
Anti-epileptic medications (AEDs) are an important group of medications and their use is increasing for treatment of not alone epilepsy but for their indications for mental illness such as bipolar affective disorder and schizoaffective disorder. There has been concern since the 1960s that these medications impacted on bone health and this was initially studied in people with epilepsy. This study was carried out to examine the totality of evidence from primary studies about fracture risk and falls risk in people using AEDs, regardless of the indication for use. This study consists of a systematic review of prospective cohort studies examining fracture and falls in adults using AEDs, regardless of indication. Eleven studies were selected for inclusion, seven from the United States, two from the Netherlands and one each from Finland and the United Kingdom. The results of the included studies were analysed and assessed from the standpoint of methodological quality. The studies were compared across their main outcomes of interest; risk of fracture and risk of fall. It was found that there was an increased risk of fracture with AED use and three of the five studies looking at falls found the risk to be increased. Initial and repeat prescriptions for AED treatment (with its risks of side effects) require the same attention to the four principles of bioethics as all medical care should receive. This process should be structured, aided and, if necessary informed, by regulatory and legal percept which have been developed over years of interaction between the legal system and complex healthcare matters.