Determinants of low bone mineral density in children with epilepsy

Fong, Choong Yi; Kong, Ann Nie; Noordin, Mazidah; Poh, Bee Koon; Ong, Lai Choo; Ng, Ching Ching

doi:10.1016/j.ejpn.2017.10.007

Cited by 15 publications

(7 citation statements)

References 34 publications

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“…This is the first study to report that children on enzyme-inducing ASMs have lower levels of 25(OH)D 2 and 24,25(OH) 2 D 3 levels probably as result of increased destruction of vitamin D. The median duration of ASMs was five and a half years so the group had established time period of epilepsy and prolonged time period of prescribed ASMs. However, this study did not show difference in the number of ASMs used between children with vitamin D deficiency and those without, compared to other studies which have shown polytherapy to be associated with lower vitamin D levels [19,21,22,27,28,40,42,43]. Our cohort was recruited from a tertiary center which manages a greater proportion of children with severe forms of epilepsy requiring multiple ASMs.…”

Section: Discussioncontrasting

confidence: 55%

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Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa.

Kija

Gidal

Shapson-Coe

et al. 2019

Seizure

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A B S T R A C TPurpose: The effects of antiseizure medications (ASMs) on bone metabolism is inconsistent. Most studies are in high income settings and none from sub-Saharan Africa.Methods: A hospital based cross-sectional study in a paediatric epilepsy service with a comparison group assessed vitamin D metabolism.Results: Seventy-five children with epilepsy and 75 comparison group were recruited. Median age for children with epilepsy was 9 years (range 1-17 years) and controls 3 years (range 1-12 years). Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD 2 (p = 0.0018), vitaminD 3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products.Conclusions: Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzymeinducing ASMs have lower levels of Vitamin D 2 and D 3 levels, probably as result of increased destruction of vitamin D. Improved vitamin D intake for children in vulnerable settings is important.in the liver to form 25-hydroxyvitamin D 3 and subsequently 1α hydroxylation in the kidneys to form 1α, 25 dihydroxy-vitamin D 3 . The degradation of Vitamin D 3 in the kidneys occurs through an enzyme CYP24 to form the metabolites 24, 25 dihydroxy-vitamin D 3 and 1α, 24, 25 trihydroxy-vitamin D 3 [6,7]. In vitro studies support that CYP3A4 catalyzes the hydroxylation of 125 dihydroxy vitamin D 3 into inactive metabolites in the liver and small intestines, where CYP24A1 is nearly absent, which results in decreased intestinal calcium uptake. Notably, CYP3A4 also contributes to the catabolism of 25 hydroxy vitamin D 3 by catalyzing its hydroxylation into 425 dihydroxy vitamin D 3 [8].ASMs induce hepatic cytochrome P450 enzymes, especially https://doi.

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Section: Discussioncontrasting

confidence: 55%

“…Some specifically highlight the increased impact from monotherapy with sodium valproate, carbamazepine and levetiracetam [23][24][25][26]. Other studies conclude that the key risks are polypharmacy and chronic ASM use [21,22,27]. Table 1 summaries some of the key cohort studies illustrating the variation in findings.…”

Section: Retrospective Longitudinal 172mentioning

confidence: 99%

Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa.

Kija

Gidal

Shapson-Coe

et al. 2019

Seizure

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“…In a study among Polish children with decreased bone mass, ApaI polymorphism was associated with an increased bone mineral density and slower bone mass loss [37]. However, in our subgroup of CWE no association was found between ApaI polymorphism and bone mineral density [38]. As ApaI SNP has only been analysed in a limited number of studies, further larger population studies as well as functional evaluation of VDR SNP are necessary to confirm our findings.…”

Section: Discussionsupporting

confidence: 45%

Association of common genetic variants with vitamin D status in Malaysian children with epilepsy

Kong

Fong

et al. 2020

Seizure

Self Cite

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Children with epilepsy (CWE) are at risk of vitamin D deficiency. Single nucleotide polymorphisms (SNPs) affecting the vitamin D pathway are potentially important risk factors for serum 25-hydroxyvitamin D [25(OH)D] concentration. The aims of our study were to evaluate the association of vitamin D-related SNPs to serum 25(OH)D concentrations in Malaysian CWE. Methods: Cross-sectional study of Malaysian ambulant CWE on antiseizure medication for > 1 year. Sixteen SNPs in 8 genes (GC, VDR, CYP2R1, CYP24A1, CYP27B1, CYP27A1, CYP3A4, NADSYN1/DHCR7) were genotyped. Linear and logistic regression models and co-variates adjusted analyses were used. SNPs with significant associations were further analysed in a group of ethnically-matched healthy Malaysian children. Results: 239 CWE were recruited (52.7% Malay, 24.3% Chinese and 23.0% Indian) with mean serum 25(OH)D of 58.8 nmol/L (SD 25.7). Prevalence of vitamin D deficiency (≤37.5 nmol/L) was 23.0%. Minor allele of GC-rs4588-A was associated with lower serum 25(OH)D in the meta-analysis of both CWE (β -8.11, P = 0.002) and Malaysian healthy children (β -5.08, P < 0.001), while VDR-rs7975232-A was significantly associated with reduced odds of vitamin D deficiency in Malay subgroup of CWE (OR: 0.16; 95% CI: 0.06-0.49; P = 0.001) and this association was not found in the healthy children group. Conclusions: Our results suggest that GC-rs4588 is associated with lower serum 25(OH)D concentration in both Malaysian CWE and healthy children, while VDR-rs7975232A is associated with lower risk of vitamin D deficiency in Malaysian CWE of Malay ethnicity. Our findings may assist in the genetic risk stratification of low vitamin D status among CWE.

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“…(Khan et al 2017) proposed an image processing algorithm for estimating BMD using digital X-ray images but Graphic user Interface was needed. Fong Choong (Fong et al 2018) illustrated the statistical analysis of low BMD of epileptic children (neurological disorder) with long-term Antiepileptic Drugs (AED) and this can be diagnosed using DEXA that measures child lumbar spine.…”

Section: Figure 4 and 5: Full Spine X-ray Image And Spine Roi Detectionmentioning

confidence: 99%

Path way for Critical Review on Early Prediction of Bone Density Through Various Techniques

Ashmad¹

2020

Biosci. Biotech. Res. Comm

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Recent advancements in medical applications like detecting bone density in early stages is utmost necessary to save human lives. In this connection finding the amount of mineral or calcium content present in the bone or bone tissue plays a critical role, for that Bone Densitometer are utilizes to find exact Bone Mineral Density(BMD) or bone density values that give information about the structure of bone. Generally, Bone Densitometer gives two forms of results one is T-score and the other is Z-score. If the value of T-score and Z-score is less than the threshold value, then the density of bone is reduced and it will lead to chances of bone fracture. Frequently used bone densitometers are like Dual Energy X-ray Absorptiometry (DEXA) and Radiographic machines like CT and MRI. This review article describes the volumetric and critical review on various techniques exists so far to determine the bone density from these it was observed that CT and MRI are most expensive and it generates more radiation which causes problems for human. Till now in literature the recorded accuracy with these methods are low. Finally, the inference drawn from literature had given a thought thatthe usage of normal X-Ray machine when compared to existed methods may give better accuracy.

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Determinants of low bone mineral density in children with epilepsy

Cited by 15 publications

References 34 publications

Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa.

Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa.

Association of common genetic variants with vitamin D status in Malaysian children with epilepsy

Path way for Critical Review on Early Prediction of Bone Density Through Various Techniques

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