Determine how often patients on enzyme-inducing anti-epileptic drugs (EIAED) in the neurology outpatient office are screened for bone density and vitamin D supplementation and determine future need for quality improvement

Some anti-seizure medications are known to cause changes in bone health, specifically increasing risk of developing osteopenia or osteoporosis.  Guidelines on how to best monitor for these changes have been scant with some reports suggesting measures of bone metabolism (bone density scans (DEXA), calcium, Vitamin D, alkaline phosphatase) should be checked every 2-5 years in patients taking enzyme-inducing anti-seizure medications (NICE, 2004). Limited data is available regarding adequate preventive strategies such as Vitamin D supplementation which could potentially lead to improved bone health while on these medications (Fernandez et al, 2018). 

The study was a retrospective chart review of patients with a diagnosis of epilepsy seen in the UConn Health outpatient neurology offices during a one year period (7/2018-7/2019). Charts were reviewed for variables: EIAED use, dose and duration, Vitamin D and calcium supplementation, Vitamin D levels, bone density screening with DEXA scans, age, and gender.

A total of 388 patients on EIAED for epilepsy were identified. These were mainly carbamazepine, phenytoin, and oxcarbazepine with smaller representation of others. Of these, 67 patients underwent DEXA scan, 21 which were ordered by neurology. Of these 21, 8 were abnormal. Those with abnormal scans tended to be female and age greater than 50. 248/388 of eligible patients were not on calcium or Vitamin D supplementation.

There is room for improvement for neurologists to screen high risk patients for osteoporosis and osteopenia as well as supplementing those high risk patients with calcium and Vitamin D. Â鶹´«Ã½Ó³»­ in identifying high risk patients will improve quality care in outpatient offices. A future project will investigate if there was better screening after educational intervention.