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Published on: December 18, 2016
Fracture Risk With Lacosamide vs Levetiracetam Monotherapy in Adults With Epilepsy
Majd A AbuAlrob1, Ali Al-Salahat2, Rand Abdellatif3
1Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
Neurology
|July 20, 2026
Summary
Lacosamide monotherapy in epilepsy patients showed a higher fracture risk compared to levetiracetam. This finding is crucial for selecting antiseizure medications (ASMs) in individuals with bone fragility.
Area of Science:
- Neurology
- Pharmacology
- Orthopedics
Background:
- Epilepsy patients face increased fracture risks.
- Comparative skeletal safety data for newer antiseizure medications (ASMs) are limited.
- Understanding fracture risk associated with specific ASMs is vital for patient care.
Purpose of the Study:
- To compare fracture risk between lacosamide and levetiracetam monotherapy in adults with epilepsy.
- To evaluate the skeletal safety profile of lacosamide versus levetiracetam.
- To provide evidence for informed ASM selection in epilepsy management.
Main Methods:
- Retrospective cohort study utilizing the TriNetX Global Collaborative Network.
- Identified adults with epilepsy initiating lacosamide or levetiracetam monotherapy.
- Used propensity score matching and Cox regression to analyze composite fracture risk over 5 years.
Main Results:
- Lacosamide monotherapy (2.86%) was associated with a significantly higher composite fracture risk than levetiracetam (2.09%) (HR 1.27; p < 0.001).
- Elevated risks for forearm fracture, major osteoporotic fracture, and incident osteoporosis were observed with lacosamide.
- Sensitivity analyses confirmed the increased fracture risk associated with lacosamide.
Conclusions:
- Lacosamide monotherapy is linked to a significantly higher fracture risk compared to levetiracetam in adults with epilepsy.
- Findings suggest careful consideration of lacosamide in patients with pre-existing skeletal fragility.
- The retrospective design necessitates caution in inferring causality.
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