Epilepsy and fracture risk: a meta-analysis

Objective: To investigate the influence of epilepsy seizure on the fracture risk through a retrospective literature review. Methods: Published studies August 1, 2015 were acquired from the PubMed, EMBASE, Springer Link, Ovid using the key words “epilepsy” and “fracture”. A total of 828 papers were picked up, which were further screened to select the most relevant ones. Three selection criteria for inclusion were decided, and finally 11 studies fulfilled the criteria and were included in the study. The procedure of meta-analysis was determined before beginning the study by a group discussion, and at least three studies each for hip, spinal, and forearm fractures were considered for the analysis. The random effect model based on DerSimonian and Laird estimation was utilized in the fracture risk analysis. The weights analysis was conducted to analyze the risk of fracture caused by epilepsy seizures. The publication bias was tested by funnel plots. Results: The general fracture risk increased significantly for epilepsy patients than for fracture patients without epilepsy [relative risk (RR) = 1.97, 95% confidence interval (CI): 1.89-2.05; from five papers]; and six, six, and three papers described the hip fracture risk (RR = 4.43, 95% CI: 2.846.92), forearm fracture risk (RR = 1.71, 95% CI: 1.29-2.27), and spinal fracture risk (RR = 3.51, 95% CI: 1.69-7.29), respectively. Among all factors, around 35% fractures were associated with epilepsy seizures. Conclusion: Patients with epilepsy may encounter a higher risk of fracture, especially on the spine and the hip.