Bone mineral density, vitamin D and anticonvulsant therapy

Filardi, Silvana; Guerreiro, Carlos A. M.; Magna, Luís Alberto; Neto, João Francisco Marques

doi:10.1590/s0004-282x2000000400003

Cited by 33 publications

(26 citation statements)

References 11 publications

(14 reference statements)

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“…Other studies in more sunny regions, where the dermal production of the vitamin D precursor was normal, showed neither hypovitaminosis D nor abnormalities of bone metabolism in epileptic patients 9,28 . For example, male AED users in Campinas (latitude 20 -24 degrees South) showed no difference between BMD, 25OHD and 1,25OHD of patients when compared to a control group matched by age and BMI 9 .…”

Section: Discussionmentioning

confidence: 82%

“…Studies indicate that 20 to 60% of AED users can develop rickets or osteomalacia, especially among older and institutionalized patients. However, in outpatient populations, some studies have not demonstrated a deleterious effect of AED on bone metabolism [7][8][9] . Drugs such as CBZ, PB, PRM and DPH are known to induce hepatic mixed function oxidase activity throughout the microsomal enzymes (P450) in the liver.…”

Section: Palavras-chave: Drogas Antiepiléticas Indutoras Hepáticas 2mentioning

confidence: 99%

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Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Kulak

Borba

Bilezikian

et al. 2004

Arq. Neuro-Psiquiatr.

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-The aim of this cross sectional study was to evaluate bone mineral density (BMD) and serum levels of 25-hydroxy vitamin D (25OHD) in a group of patients taking antiepileptic drugs (AED) for a seizure disorder. Between May-2001 and January-2003, we evaluated 58 patients (40 women/18 men), 34.4+6 years old living in Curitiba or in its metropolitan area, on antiepileptic therapy for 2 to 38 years (10 on monotherapy /48 on multiple drugs regime). The group was matched by age, gender, and bone mass index to 29 healthy subjects (20 women/ 9 men); 34.2+5.9 years old. Medical history and physical exam were performed on all subjects with particular information sought about fractures and risks factors for osteoporosis. Blood samples were collected for total serum calcium, albumin, phosphorus, creatinine, total alkaline phosphatase, and liver function tests. BMD of the lumbar spine, femur and forearm was determined by dual energy X-ray absorptiometry (DXA, Hologic QDR 1000). Between February and April-2003, other blood samples were collected to measure 25OHD, intact paratohormone (PTH) and calcium. Unemployment and smoking history were more frequent among patients than among controls (p<0.05). Fifteen patients had a fracture history, all of which occurred during a seizure. The BMD of the lumbar spine (0.975+0. 13 g/cm 2 vs. 1.058+0.1 g/cm 2 ; p<0.03) and of the total femur (0.930+0.1 g/cm 2 vs. 0.988+0.12 g/cm 2 ; p<0.02) was lower in patients than in controls. In 63.5% of patients and in 24.1 % of controls a T-score < -1.0 in at least one site was seen. The AED users had higher total alkaline phosphatase and lower 25OHD (p<0.02). No correlations between BMD and 25OHD were found. The use of phenytoin was correlated with a greater incidence of fractures (RR: 2.38). We conclude that patients on chronic use of AED have alterations in bone metabolism characterized in this study by lower BMD of the lumbar spine and total femur and lower serum concentrations of 25OHD.KEY WORDS: Enzyme-inducing antiepileptic drugs, 25OH vitamin D, osteomalacia. Densidade mineral óssea e níveis séricos de 25 OH vitamina D em usuários crônicos de drogas antiepilépticasRESUMO -O objetivo deste estudo transversal foi avaliar a densidade mineral óssea (DMO) e os níveis de 25hidroxi vitamina D (25OHD) em um grupo de pacientes com epilepsia e usuários crônicos de drogas antiepilépticas (DAE). Entre maio-2001 e janeiro-2003 avaliamos 58 pacientes (40 mulheres/18 homens) residentes em Curitiba ou região metropolitana da cidade, com média de idade 34,4+6 anos e tempo de tratamento entre 2 e 38 anos (10 em monoterapia/48 em politerapia). O grupo de pacientes foi emparelhado por idade, sexo e índice de massa corpórea com 29 indivíduos aparentemente sadios (20 mulheres/9 homens; 34,2+5,9 anos). Pacientes e controles foram submetidos a anamnese e exame clínico, com ênfase na história de fraturas e fatores de risco para osteoporose. Nas visitas foram coletadas amostras de sangue para dosagens de cálcio, albumina, fósforo, creatinina, fosfatase alcalin...

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Section: Discussionmentioning

confidence: 82%

Section: Palavras-chave: Drogas Antiepiléticas Indutoras Hepáticas 2mentioning

confidence: 99%

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Kulak

Borba

Bilezikian

et al. 2004

Arq. Neuro-Psiquiatr.

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“…Exposure of arm and face skin to sunlight for 30min supplies the daily amount of vitamin D the body needs 1,39 . In Brazil, located at a latitude below 24ºS, the plasmatic levels of 25(OH) D and 1.25(OH) 2 D were normal in both healthy men and in epileptics using anticonvulsive drugs, which reduce these levels 64 .…”

Section: Vitamin Dmentioning

confidence: 94%

Fortification of industrialized foods with vitamins

Liberato

Pinheiro-Sant’Ana

2006

Rev. Nutr.

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A B S T R A C TVitamins are essential to life. Inadequate eating habits, high caloric intake and metabolic defects lead to micronutrient deficiencies, affecting more than two billion people worldwide. The increasing intake of industrialized foods, combined with low vitamin stability has led to the common practice of adding these nutrients to processed foods. This review discusses the terminology, availability, intake and risk of hypervitaminosis, due to the intake and nutritional importance of foods fortified with vitamins. The addition of nutrients should occur in foods that are effectively consumed by the target population and must meet the real needs of a significant segment of the population. In Brazil, a total of 166 products available in supermarkets are vitamin-enriched. A 10-year study involving children and adolescents in Germany showed that 90% of those surveyed used at least one fortified food. During this 10-year period, 472 fortified products were consumed. The enrichment of foods should be based on the needs of each country and, if possible, regional needs. For instance, in order to increase its intake, Vitamin D is added to foods in Denmark during the winter, mainly for the elderly. However, in Brazil, there is no evidence of the need to fortify food with this vitamin. A survey showed that of the 76 enriched dairy products, 37 contained vitamin D. Food-fortification is a very important strategy to solve nutritional deficiency problems, but it can also cause many health problems.Indexing terms: food, fortified; food habits. R E S U M O

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“…It has been reported that antiepileptic drugs might predispose to bone fractures in patients by decreasing the BMD [12][13][14][15]. Osteomalacia or osteoporosis developing in patients using antiepileptic drugs can present, with radiological, biochemical and pathological findings.…”

Section: Discussionmentioning

confidence: 99%

“…They may therefore cause important changes in adolescents during pubertal development and on fertility. Additionally, it has been known for over 30 years that some antiepileptic drugs have predisposed patients to bone fractures by decreasing bone mineral density (BMD) [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

The effects of oxcarbazepine treatment on vitamin B12 and folate levels, thyroid functions, sex hormones, and bone mineral density in epileptic patients

et al. 2009

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AbstractThe aim of this study was to evaluate vitamin B12 and folate levels, thyroid functions, sex hormones and bone mineral density in idiopathic epileptic patients taking oxcarbazepine as monotherapy. Newly diagnosed pediatric patients with idiopathic partial epilepsy taking oxcarbazepine (OXC) as monotherapy were enrolled in this study. The pre-treatment and 6 months post-treatment values of vitamin B12, folate, thyroid functions, sex hormones, and bone mineral density (BMD) were obtained from all patients. A total of 32 patients (22 (68.8%) males and 10 (31.2%) females) were included in this study. The mean age was 7.4 ± 3.2 years (range: 2–14 years). There were no significant differences between the pre-treatment and 6 months post-treatment values of vitamin B12, folate, thyroid functions, sex hormones, and BMD. However, the 6 month post-treatment sex hormone binding globulin (SHBG) values (159.92 ± 48.14 nmol/L) were significantly higher than the pre-treatment values (137.88 ± 43.12 nmol/L) (p=0.009). We found that OCX treatment in children did not have an effect on serum folate and vitamin B12 levels, thyroid functions, sex hormones and BMD but caused increased SHBG. Over time, the increase in serum SHBG levels may lead to diminished bioactivity of sex steroids, and thus to reduced fertility. The further studies are needed to demonstrate the clinical importance of increased SHBG levels.

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Bone mineral density, vitamin D and anticonvulsant therapy

Cited by 33 publications

References 11 publications

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Fortification of industrialized foods with vitamins

The effects of oxcarbazepine treatment on vitamin B12 and folate levels, thyroid functions, sex hormones, and bone mineral density in epileptic patients

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