Greater Calcium Intake is Associated with Better Bone Health Measured by Quantitative Ultrasound of the Phalanges in Pediatric Patients Treated with Anticonvulsant Drugs.

Vicente Vera,Jose Moran,Juan Pedrera-Zamorano,Maria Canal-Macias,Raul Roncero-Martin,Patricia Barros,Carmen Costa-Fernandez,Jesus Lavado-Garcia,Rafael Guerrero-Bonmatty

doi:10.3390/nu7125517

Abstract

We aimed to investigate and compare the effects of chronic antiepileptic therapy on bone health in pediatric patients using quantitative ultrasound of the phalanges (QUS) and controlling for potential confounding factors, particularly nutrient intake. The amplitude-dependent speed of sound (Ad-SoS) was measured in 33 epileptic children and 32 healthy children aged 6.5 ± 3.1 and 6.3 ± 1.1 (mean ± SD) years, respectively. There were no significant differences in the demographics such as age, weight and height between epileptic children and the control group children. None of the children in the epileptic or the treatment group were found to have a vitamin D deficiency. There were no significant differences in laboratory tests between groups. Lower QUS figures were found in the epileptic children (p = 0.001). After further adjustment for potential confounders such age, height, weight, calcium intake, vitamin D intake, physical activity and sex, the differences remained significant (p < 0.001). After further classification of the participants based on the tertile of calcium intake, no significant differences were found between patients and healthy controls in the greatest tertile of calcium intake (p = 0.217). We conclude that anticonvulsant therapy using valproate may lead to low bone mass in children and that an adequate intake of calcium might counteract such deleterious effects.

Highlights

The association of skeletal abnormalities with chronic antiepileptic therapy (AED) was first described approximately three decades ago, and most of the available data are from adults [1]
There were no significant differences in the demographics such as age, weight and height between the epileptic children and the control group
There were no significant differences in serum 25-hydroxyvitamin D, phosphorous, parathyroid hormone, alkaline phosphatase, bone alkaline phosphatase and calcium levels between the groups studied (Table 1)

Summary

Introduction

The association of skeletal abnormalities with chronic antiepileptic therapy (AED) was first described approximately three decades ago, and most of the available data are from adults [1]. AEDs were associated with several abnormalities in calcium metabolism, including hypocalcemia, hypophosphatemia, elevated levels of serum alkaline phosphatase and serum parathyroid hormone, reduced serum levels of biologically active vitamin D metabolites, radiologic evidence of rickets, and histologic evidence of osteomalacia [2,3,4]. The majority of these studies were performed in adult patients, and data from children receiving AEDs are not fully clear. Ad-SoS is strictly dependent on the thickness of the soft tissue surrounding the phalanges. The second parameter BTT is independent of the soft tissue surrounding the phalanges so both parameters complement each other

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