The problem of osteoporosis in epileptic patients taking antiepileptic drugs

Miziak, Barbara; Błaszczyk, Barbara; Chrościńska–Krawczyk, Magdalena; Danilkiewicz, Grzegorz; Jagiełło-Wójtowicz, E; Czuczwar, Stanisław J.

doi:10.1517/14740338.2014.919255

Cited by 46 publications

(39 citation statements)

References 107 publications

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“…Timely withdrawal of AEDs and proper use of a new medication may avoid serious disabilities in users. In addition, supplementation of calcium and vitamin D are still recommended to epileptic patients on AEDs even though the effects of supplementation on AED-related osteopathy are controversial [206]. …”

Section: Discussionmentioning

confidence: 99%

The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism

Fan

Lee

Chang

et al. 2016

IJMS

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Epilepsy is a common neurological disorder worldwide and anti-epileptic drugs (AEDs) are always the first choice for treatment. However, more than 50% of patients with epilepsy who take AEDs have reported bone abnormalities. Cytochrome P450 (CYP450) isoenzymes are induced by AEDs, especially the classical AEDs, such as benzodiazepines (BZDs), carbamazepine (CBZ), phenytoin (PT), phenobarbital (PB), and valproic acid (VPA). The induction of CYP450 isoenzymes may cause vitamin D deficiency, hypocalcemia, increased fracture risks, and altered bone turnover, leading to impaired bone mineral density (BMD). Newer AEDs, such as levetiracetam (LEV), oxcarbazepine (OXC), lamotrigine (LTG), topiramate (TPM), gabapentin (GP), and vigabatrin (VB) have broader spectra, and are safer and better tolerated than the classical AEDs. The effects of AEDs on bone health are controversial. This review focuses on the impact of AEDs on growth and bone metabolism and emphasizes the need for caution and timely withdrawal of these medications to avoid serious disabilities.

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Section: Discussionmentioning

confidence: 99%

The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism

Fan

Lee

Chang

et al. 2016

IJMS

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“…Besides glucocorticoid therapy and aromatase and GnRH inhibitors, which are treated separately in these guidelines, The use of pioglitazone and rosiglitazone is associated with a significant increase (3-to 4-fold) in the risk of hip and humerus fractures in postmenopausal women (46). A large body of evidence is available on the association of some first generation anticonvulsants (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone) with low bone mass, as well as with a 2-to 6-fold increased risk of hip fracture in patients with epilepsy, especially when polymedicated (47). The use of cyclosporine in transplanted patients is associated with an increase in clinical fractures that ranges from 10% to 34% in the first year of treatment (48).…”

Section: Osteoporosis Related To Other Drugsmentioning

confidence: 99%

Guidelines for the diagnosis, prevention and management of osteoporosis

et al. 2016

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Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management

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“…A summary of pharmacokinetic interactions between antiepileptics and antidepressant drugs is shown in Table 4. [110,113] When the concomitant therapy with AEDs and antidepressants is needed it is necessary to remember that some adverse effects following this therapy may appear and heighten because of additive effects.…”

Section: Expert Opinion On Drug Metabolism and Toxicologymentioning

confidence: 99%

Pharmacokinetic/pharmacodynamic considerations for epilepsy – depression comorbidities

Banach

Popławska

Błaszczyk³

et al. 2016

Expert Opinion on Drug Metabolism & Toxicology

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The preclinical data may provide valuable clues on how to combine these two groups of drugs - antidepressant drugs neutral or potentiating the anticonvulsant action of antiepileptics are recommended in this regard. Avoidance of antidepressants clearly decreasing the convulsive threshold or decreasing the anticonvulsant efficacy of antiepileptic drugs (f.e. bupropion or mianserin) in patients with epilepsy is recommended.

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The problem of osteoporosis in epileptic patients taking antiepileptic drugs

Cited by 46 publications

References 107 publications

The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism

The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism

Guidelines for the diagnosis, prevention and management of osteoporosis

Pharmacokinetic/pharmacodynamic considerations for epilepsy – depression comorbidities

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