{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:22:45Z","timestamp":1790256165224,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,6,25]],"date-time":"2023-06-25T00:00:00Z","timestamp":1687651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to determine the age, gender, and site\u2010specific prevalence of fractures in people with epilepsy (PWE) and matched general population comparators in a nationwide study in North Macedonia between 2015 and 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PWE and matched controls were selected through a systematic search of the electronic National Health System (eNHS). We determined the period prevalence (PP) of all site\u2010specific fractures. We also calculated gender and age\u2010specific incidence rate ratios (IRR) for various fractures. Odds ratios (ORs) and risk ratios (RR) were estimated for the number and type of ASM as well as comorbid conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 13\u2009818 prevalent epilepsy cases, 6383 (46.2%) were females, and 7435 (53.8%) were males. 109 PWE out of 1000 had at least one fracture during the study period and ~8 people out of 1000 in the general population. The most frequent sites in terms of PP both in PWE and controls, were fractures of the lower arm, hip and femur, and lower leg. Significant differences in PP for all fracture locations were observed between PWE and controls (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The noticeable differences of \u223c100 times higher PP were observed for fractures of the skull and jaw in PWE. IRR of any fracture in PWE was 272.84\/10\u2009000 person\u2010years; higher in the older age groups and among people who received &gt;2 ASM. Fracture risk was increased with the use of &gt;2 ASM (OR: 1.56; 95% CI: 1.32\u20101.84 and RR: RR: 1.32). The presence of comorbidities also increased fractures risk (OR: 1.24; 95% CI: 1.10\u20101.38).<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>This population\u2010based study depicts a higher fracture prevalence in PWE compared to the general population. A higher number of ASM and the presence of comorbidities increase the risk of fractures and targeted prevention might be needed in those subgroups of PWE.<\/jats:p><\/jats:sec>","DOI":"10.1002\/epi4.12776","type":"journal-article","created":{"date-parts":[[2023,6,19]],"date-time":"2023-06-19T14:24:28Z","timestamp":1687184668000},"page":"1028-1037","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Fractures in people with epilepsy: A nationwide population\u2010based cohort study"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0476-5049","authenticated-orcid":false,"given":"Marija","family":"Babunovska","sequence":"first","affiliation":[{"name":"University Clinic for Neurology, Faculty of Medicine Ss. Cyril and Methodius University  Skopje North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8221-3357","authenticated-orcid":false,"given":"Aleksandar","family":"Jovanovski","sequence":"additional","affiliation":[{"name":"Clinic for Neurology, Early Rehabilitation and Complex Neurological Treatment Evangelical Clinics  Gelsenkirchen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bojan","family":"Boskovski","sequence":"additional","affiliation":[{"name":"University Clinic for Neurology, Faculty of Medicine Ss. Cyril and Methodius University  Skopje North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7037-0512","authenticated-orcid":false,"given":"Marta","family":"Foteva","sequence":"additional","affiliation":[{"name":"University Clinic for Orthopedic Surgery Ss. Cyril and Methodius University  Skopje North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Kuzmanovski","sequence":"additional","affiliation":[{"name":"University Clinic for Neurology, Faculty of Medicine Ss. Cyril and Methodius University  Skopje North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordana Kiteva","family":"Trencevska","sequence":"additional","affiliation":[{"name":"University Clinic for Neurology, Faculty of Medicine Ss. Cyril and Methodius University  Skopje North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9247-3953","authenticated-orcid":false,"given":"Emilija","family":"Cvetkovska","sequence":"additional","affiliation":[{"name":"University Clinic for Neurology, Faculty of Medicine Ss. 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