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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: Attention to fracture
prevention is important when anticonvulsants are prescribed in spinal cord
injury, particularly when more than one anticonvulsant is used.

Langue : ANGLAIS