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Enzyme-inducing antiseizure drugs (ASDs) are associated with increased odds of incident osteoporosis or osteopenia, but vitamin D supplementation is underutilized, according to a study presented at the annual meeting of the American Neurological Association, held from Oct. 17 to 20 in San Diego.

Mehreen Ali, from Carle Illinois College of Medicine in Urbana, and colleagues used data from the All of Us Research Program to examine new diagnoses of osteoporosis or osteopenia after patients received a first prescription for an ASD. A total of 1,395 adults on enzyme-inducing ASDs were compared to 15,374 adults on non-enzyme-inducing ASDs. Vitamin D supplementation initiated after ASD exposure was ascertained.

The researchers found that enzyme-inducing ASD use was independently associated with increased odds of incident osteoporosis or osteopenia after full adjustment for age, sex, corticosteroid use, chronic kidney disease (CKD), obesity and vitamin D supplementation (adjusted odds ratio, 1.51). The association was not due to measured confounders, with minimal attenuation seen from unadjusted to adjusted estimates.

Corticosteroid use and CKD were independently associated with bone disease (odds ratios, 1.56 and 1.61, respectively), while obesity was protective (odds ratio, 0.82). Only 20.7% of patients on enzyme-inducing ASDs received vitamin D supplementation postdiagnosis compared with 16.2% of patients on non-enzyme-inducing ASDs.

"What's most striking about this finding is not the bone disease risk itself—we expected that—but how few patients were receiving vitamin D supplementation, suggesting there is a significant gap between what guidelines recommend and what is actually happening in clinical practices," Ali said.

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