Long-Term Influence of Anticonvulsant Agents on Calcitonin, Parathyroid Hormone and Osteocalcin

Rico, H.; Seijas, E. Varela de; Rubio-Arias, Jacobo Á.; Cabranes, José A.

doi:10.1159/000116854

Cited by 8 publications

(3 citation statements)

References 17 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Verrotti et al (22) reported that VPA doses do not seem to change bone turnover in adult epileptic patients. This could be explained by vitamin D-independent pathways such as impaired calcium absorption (26), resistance to parathyroid hormone and inhibition of calcitonin secretion (27), direct effects of AEDs on bone cells (9), hyperparathyroidism and calcitonin deficiency (39). …”

Section: Discussionmentioning

confidence: 99%

Bone Status in Patients with Epilepsy: Relationship to Markers of Bone Remodeling

et al. 2014

View full text Add to dashboard Cite

Patients with epilepsy and treated with antiepileptic drugs (AEDs) may develop metabolic bone disease; however, the exact pathogenesis of bone loss with AEDs is still unclear. Included were 75 adults with epilepsy (mean age: 31.90 ± 5.62 years; duration of treatment with AEDs: 10.57 ± 3.55 years) and 40 matched healthy controls. Bone mineral content (BMC) and bone mineral densities (BMD) of the femoral neck and lumbar spine were measured using dual-energy X-ray absorptiometry (DEXA). Blood samples were analyzed for calcium, magnesium, phosphate, alkaline phosphatase (ALP), 25-hydroxy vitamin D (25OHD), soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), osteoprotegerin (OPG), and OPG/RANKL ratio (markers of bone remodeling). Compared to controls, patients had lower BMD, BMC, Z-score, and T-score at the femoral neck and lumbar spine (all p < 0.001). Seventy-two percent and 29.33% of patients had osteoporosis of the lumbar spine and femoral neck. Patients had significantly lower serum calcium, 25(OH)D, and OPG and higher ALP, sRANKL levels, and sRANKL/OPG (all p < 0.001). Fifty-two percent of patients had hypocalcemia, 93% had hypovitaminosis D, 31% had high levels of sRANKL, and 49% had low levels of OPG. No differences were identified between DEXA and laboratory results in relation to the type, dose, or serum levels of AEDs. BMD at the femoral neck and lumbar spine were found to be correlated with the duration of illness (p = 0.043; p = 0.010), duration of treatment with AEDs (p < 0.001; p = 0.012), and serum levels of 25(OH)D (p = 0.042; p = 0.010), sRANKLs (p = 0.005; p = 0.01), and OPG (p = 0.006; p = 0.01). In linear regression analysis and after adjusting for gender, age, weight, duration, and number of AEDs, we observed an association between BMD, 25(OH)D (p = 0.04) and sRANKL (p = 0.03) concentrations. We conclude that AEDs may compromise bone health through disturbance of mineral metabolism and acceleration of bone turnover mechanisms.

show abstract

Section: Discussionmentioning

confidence: 99%

Bone Status in Patients with Epilepsy: Relationship to Markers of Bone Remodeling

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The issue of whether or not certain antiepileptic drugs affect the bone metabolism of the recipients remains rather controversial [1][2][3][4][5][6][7][8][9] . In this study we attempted to investigate whether AP and its isoenzyme activity indicate any alterations of bone metabolism in children on antiepileptic medications.…”

Section: Discussionmentioning

confidence: 99%

“…However, AP isoenzyme activity has been evaluated only in adult patients on anticonvulsant monotherapy 4,5 . Several studies which assessed bone metabolism status in adults and children on antiepileptic drugs using other indicators than AP isoenzyme activity, such as biochemical markers of bone remodelling and/or calciotropic hormones, have shown rather controversial results [6][7][8][9] . The diversity of their findings could be attributed at least to some extent to the heterogeneity of population samples among different studies regarding the administered medications (monotherapy or combination therapy), the type of patients (ambulatory or institutionalized patients) or both.…”

Section: Introductionmentioning

confidence: 99%

Alkaline phosphatase and its isoenzyme activity for the evaluation of bone metabolism in children receiving anticonvulsant monotherapy

Voudris¹,

Moustaki²,

Zeis³

et al. 2002

Seizure

View full text Add to dashboard Cite

This study aimed to investigate whether carbamazepine, sodium valproate or phenobarbital as monotherapy in ambulatory epileptic children with adequate sun exposure have some effect on their bone metabolism based on the determination of total serum alkaline phosphatase (AP) levels and its bone isoenzyme activity. Blood samples were obtained from 118 epileptic children (37 on carbamazepine, 47 on sodium valproate and 34 on phenobarbital) and from corresponding healthy controls matched for age, gender and anthropometric parameters. AP and its liver, bone and intestinal isoenzyme levels, other common biochemical markers of bone and liver metabolism and drug levels were measured in the study participants. Patients on carbamazepine or phenobarbital had significantly elevated AP levels accompanied by increased bone and liver isoenzyme activity compared to controls. An increase of bone AP isoenzyme values, correlated with the duration of treatment ( r= 0.49, P= 0.002), was found in children on sodium valproate without, however, a concomitant significant elevation of total AP values. We conclude that children who receive antiepileptic drugs as monotherapy, even when residing in a Mediterranean country with adequate sunlight, may have their bone metabolism affected as indicated by the elevated levels of bone AP isoenzyme. This isoenzyme, but not total AP values, could therefore be used as a marker for the selection of patients who would be benefited by a thorough evaluation of their bone metabolism profile.

show abstract

P

Albinus

Amschler

Amschler³

et al. 1994

Hagers Handbuch Der Pharmazeutischen Praxis

View full text Add to dashboard Cite

Long-Term Influence of Anticonvulsant Agents on Calcitonin, Parathyroid Hormone and Osteocalcin

Cited by 8 publications

References 17 publications

Bone Status in Patients with Epilepsy: Relationship to Markers of Bone Remodeling

Bone Status in Patients with Epilepsy: Relationship to Markers of Bone Remodeling

Alkaline phosphatase and its isoenzyme activity for the evaluation of bone metabolism in children receiving anticonvulsant monotherapy

P

Contact Info

Product

Resources

About