{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T07:46:26Z","timestamp":1762674386424,"version":"3.40.5"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T00:00:00Z","timestamp":1582761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"American Academy of Cerebral Palsy and Developmental Medicine"},{"name":"University of Michigan Office of Health Equity and Inclusion Diversity Fund"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Individuals with epilepsy have poor bone development and preservation throughout the lifespan and are vulnerable to nontrauma fracture (NTFx) and post\u2010NTFx complications. However, no studies have examined the contribution of NTFx to mortality among adults with epilepsy. The objective was to determine whether NTFx is a risk factor for mortality among adults with epilepsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from 2011 to 2016 were obtained from Optum Clinformatics Data Mart, a nationwide claims database from a single private payer in the United States. Diagnosis codes were used to identify adults (\u226518\u00a0years old) with epilepsy, NTFx, and covariates (demographics and pre\u2010NTFx cardiovascular disease, respiratory disease, diabetes, chronic kidney disease, cancer). Crude mortality rate per 100 person\u2010years was estimated. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) were determined for mortality, comparing epilepsy and NTFx (EP\u00a0+\u00a0NTFx; n\u00a0=\u00a011\u00a0471), epilepsy without NTFx (EP without NTFx; n\u00a0=\u00a050\u00a0384), without epilepsy and with NTFx (without EP\u00a0+\u00a0NTFx; n\u00a0=\u00a0423\u00a0041), and without epilepsy and without NTFx (without EP without NTFx; n\u00a0=\u00a06.8 million) after adjusting for covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 3\u2010, 6\u2010, and 12\u2010month crude mortality rates were highest among EP\u00a0+\u00a0NTFx (12\u2010month mortality rate\u00a0=\u00a08.79), followed by without EP\u00a0+\u00a0NTFx (12\u2010month mortality rate\u00a0=\u00a04.80), EP without NTFx (12\u2010month mortality rate\u00a0=\u00a03.06), and without EP without NTFx (12\u2010month mortality rate\u00a0=\u00a00.47). After adjustments, the mortality rate was elevated for EP\u00a0+\u00a0NTFx for all time points compared to EP without NTFx (eg, 12\u2010month HR\u00a0=\u00a01.70, 95% CI\u00a0=\u00a01.58\u20101.85), without EP\u00a0+\u00a0NTFx (eg, 12\u2010month HR\u00a0=\u00a01.41, 95% CI\u00a0=\u00a01.32\u20101.51), and without EP without NTFx (eg, 12\u2010month HR\u00a0=\u00a05.23, 95% CI\u00a0=\u00a04.88\u20105.60). Stratified analyses showed higher adjusted HRs of 12\u2010month mortality for EP\u00a0+\u00a0NTFx for all NTFx sites (ie, vertebral column, hip, extremities), all age categories (young, middle\u2010aged, older), and for both women and men.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Among adults with epilepsy and compared to adults without epilepsy, NTFx is associated with a higher 12\u2010month mortality rate. Findings suggest that NTFx may be a robust risk factor for mortality among adults with epilepsy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.16465","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T13:39:55Z","timestamp":1582897195000},"page":"714-724","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The mortality burden attributable to nontrauma fracture for privately insured adults with epilepsy"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2132-1527","authenticated-orcid":false,"given":"Daniel G.","family":"Whitney","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation University of Michigan Ann Arbor Michigan"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor 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