Bone density and bone turnover markers in patients with epilepsy on chronic antiepileptic drug therapy

Abstract

In this comparative, cross-sectional study, we evaluated 55 patients with epilepsy on chronic use of antiepileptic drugs (AED); [(38 females and 17 males, 35 ± 6 years (25 to 47)] and compared to 24 healthy subjects (17 females/7 males). Laboratorial evaluation of bone and mineral metabolism including measurements of bone specific alkaline phosphatase (BALP) and carboxyterminal telopeptide of type I collagen (CTX-I) were performed. Bone mineral density (BMD) was measured by DXA. BALP and CTX-I levels did not differ significantly between the groups. CTX-I levels were significantly higher in patients who were exposed to phenobarbital (P< 0.01) than those who were not. Patients presented BMD of both sites significantly lower than the controls (0.975 ± 0.13 vs. 1.058 ± 0.1 g/cm 2 ; p= 0.03; 0.930 ± 0.1 vs. 0.988 ± 0.12 g/cm 2 ; p= 0.02, respectively). Total hip BMD (0.890 ± 0.10 vs. 0.970 ± 0.08 g/cm 2 ; p< 0.003) and femoral neck (0.830 ± 0.09 vs. 0.890 ± 0.09 g/cm 2 ; p< 0.03) were significantly lower in patients who had been exposed to phenobarbital, in comparison to the non-phenobarbital users. In conclusion, patients on AED demonstrate reduced BMD. Among the AED, phenobarbital seems to be the main mediator of low BMD and increases in CTX-I. Neste estudo comparativo, transversal, 55 pacientes com epilepsia [38 mulheres e 17 homens; 35 ± 6 anos (25 a 47anos)] foram comparados com 24 indivíduos normais (17 mulheres / 7 homens). Foi realizada uma avaliação laboratorial do metabolismo ósseo e mineral incluindo a dosagem de fosfatase alcalina específica óssea (BALP) e telopeptídeo carboxiterminal do colágeno tipo I (CTX-I). Densidade mineral óssea (DMO) da coluna lombar e do fêmur foi medida por DXA. BALP e CTX-I não foram diferentes entre os grupos. CTX-I foi significativamente mais elevado nos pacientes expostos ao fenobarbital do que os que não usaram essa medicação (p< 0,01). DMO de ambos os sítios foi menor no grupo de pacientes (0,975 ± 0,13 vs. 1,058 ± 0,1 g/cm 2 ; p= 0,03; 0,930 ± 0,1 vs. 0,988 ± 0,12 g/cm 2 ; p= 0,02, respectivamente). DMO do fêmur total (0,890 ± 0,10 vs. 0,970 ± 0,08 g/cm 2 ; p< 0,003) e colo do fêmur (0,830 ± 0,09 vs. 0,890 ± 0,09 g / c m 2 ; p< 0,03) foi significativamente menor nos pacientes que usaram fenobarbital. Em conclusão, pacientes portadores de epilepsia em uso crônico de drogas antiepilépticas (DAE) demonstraram uma redução da DMO. Entre as DAE, o fenobarbital parece ser o principal mediador da diminuição da DMO e do aumento do CTX-I.

Vitamin D deficiency in children and adolescents submitted to hematopoietic stem cell transplantation

“…Compliance may have been a problem and this was not addressed directly in the study. Another explanation might be related to alterations in dietary intake due to gastrointestinal abnormalities, which are more common in these patients, or the use of corticosteroids, cyclosporin and anticonvulsants that may also interfere with the vitamin D metabolism 4., 18., 23., 24.. Lastly, these patients received formal recommendations from their doctors for reclusion after HSCT, and to avoid any sun exposure in order to prevent GVHD and new cases of cancer.…”

Bone Turnover Markers: Basic Biology to Clinical Applications

“…Lamotrigine has not been associated with changes in BMD or BTMs ( 263 ). Benzodiazepines have been associated with an increased risk of fractures, but there are no data on BTMs ( 260 , 265 ). Gabapentin has been associated with a decrease in BMD but changes in BTMs have not been reported ( 262 ).…”

Treatment with Antiepileptic Agent Perampanel Suppresses Bone Formation and Enhances Bone Resorption: A Bone Histomorphometric Study in Mice

“…Certain pathological states and drugs affect normal bone remodeling, which can induce skeletal disorders, such as osteopenia or osteoporosis 12) . AEDs such as phenobarbital 13,14) , carbamazepine 13) , and valproic acid 13,15,16) affect bone formation and/or bone resorption, which is associated with an increased risk of fracture and reduction of bone volume in patients with epilepsy. Bone histomorphometry is a useful technique that allows the simultaneous assessment of changes in the bone microarchitecture and bone remodeling processes 17) .…”