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Abstract
BackgroundAn association between antiepileptic drugs, low bone mineral density (BMD), fractures, and abnormalities in bone metabolism has been suggested for a longer period, although conclusive evidence has not been reported.MethodsThirty epileptic patients and 30 matched healthy subjects participated in the study. Measurements of serum levels of calcium, phosphorus, vitamin D, parathormone, and alkaline phosphatase were done for included subjects. Dual-energy X-ray absorptiometry (DEXA) scan was also performed.ResultsSerum calcium, phosphorus, and vitamin D were significantly lower, whereas serum parathormone and alkaline phosphatase were significantly higher in epileptic patients compared to control subjects. Bone mineral density (BMD) abnormalities were detected in 22 patients (73.4%). A statistically significant difference in DEXA scan measurements at different regions was detected between epileptic patients and control subjects. Epileptic patients receiving enzyme inducer antiepileptic drugs (AEDs) had significantly lower serum (calcium, phosphorous, and vitamin D) and lower BMD values compared to those receiving enzyme inhibitors. Results of BMD were positively correlated with serum calcium, phosphorous, and vitamin D, while negatively correlated with serum alkaline phosphatase and duration of therapy.ConclusionsAbnormal bone health is common in epileptic patients. These abnormalities may be attributed to prolonged intake of AEDs especially enzyme inducers.
Highlights
An association between antiepileptic drugs, low bone mineral density (BMD), fractures, and abnormalities in bone metabolism has been suggested for a longer period, conclusive evidence has not been reported
Previous studies found that fracture risk was higher for hepatic enzyme inducing antiepileptic drugs (AEDs) such as phenytoin (DPH), carbamazepine (CBZ), and phenobarbital (PB) than non-inducing AEDs, while no significant effect was reported with the new AED and ethosuximide (Vestergaard et al 2004)
In view of the results of this study, we can conclude that abnormalities of bone health are common among epileptic patients
Summary
An association between antiepileptic drugs, low bone mineral density (BMD), fractures, and abnormalities in bone metabolism has been suggested for a longer period, conclusive evidence has not been reported. A large number of biochemical abnormalities affecting bone metabolism had been reported in most of epileptic patients on AEDs. A large number of biochemical abnormalities affecting bone metabolism had been reported in most of epileptic patients on AEDs These abnormalities include hypocalcemia, hypophosphatemia, low biologically active vitamin D levels, and increase in parathormone (PTH) level (Hamed et al 2014). These effects have been commonly seen with hepatic enzyme inducing AEDs which increase the catabolism of vitamin D resulting in secondary hyperparathyroidism. AEDs inhibit the cellular response to PTH resulting in increasing bone remodeling (Pascussi et al 2005)
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