Serum 25-Hydroxycalciferol Levels and Bone Mass in Children on Chronic Anticonvulsant Therapy

Hahn, Theodore J.; Hendin, Barry; Scharp, Cheryl R.; Boisseau, Vincenza C.; Haddad, John G.

doi:10.1056/nejm197503132921102

Cited by 212 publications

(92 citation statements)

References 19 publications

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“…This was particularly noteworthy considering that subjects had their blood collected in Curitiba (latitude 24-26 degrees South) at the end of the summer and beginning of fall, a period when concentrations of 25OHD are greatest 31 . Several studies also have demonstrated a decrease of 25OHD serum levels in adult and pediatric patients 3,4,6 . As was the case in our study, others have not found a correlation between lower levels of 25OHD and BMD 6 .…”

Section: Discussionmentioning

confidence: 96%

“…The AED in common use are carbamazepine (CBZ), phenytoin (DPH), phenobarbitone (PB), sodium valproate (VPA), primidone (PRM), lamotrigina (LTG) and the benzodiazepines, clobazan (CLB) and clonazepan (CZP). The chronic use of AED can affect bone and mineral metabolism [2][3][4][5][6] . Studies indicate that 20 to 60% of AED users can develop rickets or osteomalacia, especially among older and institutionalized patients.…”

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

confidence: 99%

“…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. They are thought to affect bone and mineral metabolism indirectly by increasing the metabolism of vitamin D, thereby causing vitamin D insufficiency or deficiency 2,3,6,10 . The other mechanism of the AEDs involves a direct action on bone cells, increasing bone resorption and formation.…”

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

confidence: 99%

“…The most common laboratory abnormalities described in relation to AED are hypocalcaemia, hypophosphatemia, elevated levels of alkaline phosphatase (AP), reduced levels of 25-hydroxy vitamin D (25OHD) and increased serum parathyroid hormone (PTH) 3,4,10 . The chronic use of AED is a well-known cause of secondary osteoporosis 14,15 .…”

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: 96%

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

confidence: 99%

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

confidence: 99%

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

confidence: 99%

See 2 more Smart Citations

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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“…Early investigators were mainly concerned about the potential of these drugs (mostly phenytoin and phenobarbital) to induce rickets and osteomalacia. [1][2][3] However, histologic studies in adults did not provide convincing evidence that anticonvulsant therapy as such causes osteomalacia in patients who had epilepsy without comorbidity and who were adequately exposed to sunlight. 4,5 In recent years, the focus has shifted to the question of whether the "newer" anticonvulsant drugscarbamazepine (CBZ) and valproic acid (VPA)-might increase the risk of fracture in later life by interfering with bone mass accumulation.…”

mentioning

confidence: 99%

Analysis of the Musculoskeletal System in Children and Adolescents Receiving Anticonvulsant Monotherapy With Valproic Acid or Carbamazepine

et al. 2001

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ABSTRACT. Objective. To examine bone development in children and adolescents who have uncomplicated idiopathic epilepsy and had received monotherapy with carbamazepine or valproic acid for at least 1 year.Methods. Thirty-nine patients from 6 to 19 years of age (18 girls) were studied. Total bone mineral content (BMC) and trabecular volumetric bone mineral density were measured at the distal radius using peripheral quantitative computed tomography. Maximum isometric grip force was determined with a standard dynamometer. Alkaline phosphatase activity and deoxypyridinoline (a marker of bone resorption) were assessed in serum and urine, respectively.Results. Trabecular volumetric bone mineral density was significantly decreased in the entire group (z score mean ؎ standard deviation: ؊0.62 ؎ 1.04) and in the subgroup using valproic acid (؊0.75 ؎ 1.18). In the carbamazepine subgroup, there was a similar but nonsignificant trend (؊0.50 ؎ 0.90). Total BMC and isometric maximum grip force were normal in the entire study population (0.10 ؎ 1.22) and in the 2 subgroups. The relationship between BMC and grip force was similar between patients and healthy participants. Urinary levels of deoxypyridinoline were significantly elevated above normal in the whole study population (1.35 ؎ 2.00) and in both the valproic acid and the carbamazepine subgroups.Conclusion. Bone turnover can be increased, but bone mass is adequate in children and adolescents who have uncomplicated idiopathic epilepsy and who receive monotherapy with carbamazepine or valproic acid. Pediatrics 2001;108(6). URL: http://www.pediatrics.org/ cgi/content/full/108/6/e107; anticonvulsant, bone density, bone mass, bone metabolism, muscle.ABBREVIATIONS. CBZ, carbamazepine; VPA, valproic acid; BMD, bone mineral density; vBMD, volumetric bone mineral density; pQCT, peripheral quantitative computed tomography; BMC, bone mineral content; SD, standard deviation.

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Acetazolamide-Accelerated Anticonvulsant Osteomalacia

Mallette¹

1977

Arch Intern Med

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Serum 25-Hydroxycalciferol Levels and Bone Mass in Children on Chronic Anticonvulsant Therapy

Cited by 212 publications

References 19 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

Analysis of the Musculoskeletal System in Children and Adolescents Receiving Anticonvulsant Monotherapy With Valproic Acid or Carbamazepine

Acetazolamide-Accelerated Anticonvulsant Osteomalacia

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