Levetiracetam and lamotrigine effects as mono- and polytherapy on bone mineral density in epileptic patients

Abstract

The purpose of this study was to determine the effect of lamotrigine (LTG) and levetiracetam (LEV) as mono- and polytherapy on biochemical markers of bone turnover and bone mineral density in Egyptian adult patients with epilepsy. Methods Forty-eight patients were divided into four groups: two received monotherapy of either LTG or LEV, and the other two groups received polytherapy comprising (valproate [VPA] + LTG or VPA + LEV). Thirty matched healthy participants were included in the study. Participants completed a nutritional and physical activity questionnaire. Biochemical markers of bone and mineral metabolism and bone mineral density of the lumbar spine were measured at baseline and at six months. Results In the LEV monotherapy group, the bone formation markers showed a significant decrease in serum alkaline phosphatase and serum osteocalcin levels while the bone resorption marker showed a significant increase in urinary deoxypyridinoline levels. After six months of treatment, bone mineral density showed a significant decrease in all treated groups, while among monotherapy groups, this significant decrease was more prevalent in the LEV monotherapy group compared with the LTG monotherapy group. Furthermore, there was significant negative correlation between urinary deoxypyridinoline levels and bone mineral density in the LEV monotherapy group. Conclusion Using new generation antiepileptics, LEV monotherapies and polytherapy showed harmful effects on bone but LTG did not.

Effects of zonisamide monotherapy on bone health in drug‐naive epileptic patients

“…23 Levetiracetam may not influence bone strength and metabolism negatively, 10,24 although several studies have shown that levetiracetam causes an alteration in bone density and biomarkers of bone metabolism. 25,26 Among the older and newer AEDs, lamotrigine has been associated with the lowest negative outcomes in bone health. 27 In a recent study, a significant decrease of BMD was more prevalent in the levetiracetam monotherapy group compared with the lamotrigine monotherapy group.…”

“…27 In a recent study, a significant decrease of BMD was more prevalent in the levetiracetam monotherapy group compared with the lamotrigine monotherapy group. 25 Several studies have reported a negative effect of topiramate on BMD. 28,29 Another study on long-term treatment of topiramate revealed adverse effects on bone metabolism.…”

Effects of Second-Generation Antiepileptic Drugs Compared to First-Generation Antiepileptic Drugs on Bone Metabolism in Patients with Epilepsy: A Meta-Analysis

“…Removing the study from El-Haggar et al [29], the results were influenced, which indicated that no significant difference in the change of serum calcium and ALP between LEV and first-generation AEDs groups. What is more, compared to LEV, first-generation AEDs decreased serum phosphorus more significantly.…”

“…Ten trials were included in the meta-analysis [26][27][28][29][30][31][32][33][34][35].The search flow diagram was shown in ▶Fig. 1 and the characteristics of included studies were shown in ▶ Tables 1-3.…”

“…1 and the characteristics of included studies were shown in ▶ Tables 1-3. One study by El-Haggar et al [29] described the comparative effects of LEV and LTG as mono-therapy and poly-therapy with VPA on bone metabolism in epilepsy patients, so we extracted the data of LEV or LTG combined with VPA groups in this study as the data of first-generation AEDs group. In addition, another included study [26] compared LEV and first-generation AEDs (CBZ or VPA), but they merged the data of CBZ and VPA.…”