Comprehensive insights into bone health, hormonal patterns, and fracture risks among men with drug resistant epilepsy: a crucial evaluation

Abstract

Objective To evaluate bone density and microstructure, fragility fractures, and hormones in men 50 years and older receiving antiseizure medications (ASMs). Subjects and methods Study population included 39 men with difficult-to-control epilepsy and 42 healthy men as control group. Spine and hip areal bone mineral density (aBMD), body composition and vertebral fracture assessment (VFA) were evaluated using Dual-Energy X-Ray Absorptiometry (DXA). Volumetric bone mineral density (vBMD) and microarchitecture of trabecular and cortical compartments were evaluated using High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT). Physical activity was tested by the International Physical Activity Questionnaire (IPAQ). The fracture risk was estimated by fracture risk assessment tool (FRAX). Results ASMs patients showed lower cortical bone thickness (Ct.Th) in distal tibia (1.196 ± 0.295 vs. 1.341 ± 0.241 mm, p = 0.03), more fractures (12 vs. 2, p = 0.003) mostly morphometric vertebral fractures, and a higher risk for major and hip fractures based on FRAX. Hormonal changes included higher median parathyroid hormone (PTH) (50.4 vs. 24 pg/mL, p < 0.001) possibly associated with vitamin D insufficiency, (25(OH)D levels below 30 ng/mL in 43.6% of ASMs patients), lower median Estradiol that was an independent factor for fractures (p = 0.04) and bioavailable Testosterone in the lowest quartile in 52 % of them. Conclusion Men on ASMs exhibit lower Ct.Th and hormone changes that may contribute to bone fragility. While clinical fractures are infrequent, it is crucial to actively search for morphometric fractures, either during DXA or through the more available method of spine X-rays.