Two randomized vitamin D trials in ambulatory patients on anticonvulsants

Mikati, Mohamad A.; Dib, Lea; Yamout, Bassem; Sawaya, Raja; Rahi, Amal C.; Fuleihan, Ghada El‐Hajj

doi:10.1212/01.wnl.0000247107.54562.0e

Cited by 119 publications

(82 citation statements)

References 25 publications

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“…However, in this study osteocalcin levels were not significantly affected in the phenytoin group, but they were increased in rats treated with valproic acid and increased with low-dose levetiracetam [305]. Although clinical studies have shown that these effects on bone density may be attenuated by vitamin D 3 treatment [306], more studies are needed to assess the effects of anticonvulsants on bone strength [307].…”

Section: Anticonvulsantscontrasting

confidence: 54%

“…Treatment of anticonvulsantinduced alterations of vitamin D with replacement therapy of 400e4000 IU/day of vitamin D 3 has been shown to be effective in normalizing parameters of mineral metabolism and improving bone mass [306,357,358]. In addition, treatment of anticonvulsant osteomalacia with small doses of oral 25(OH)D has also proved effective [315].…”

Section: Anticonvulsantsmentioning

confidence: 99%

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Drug and Hormone Effects on Vitamin D Metabolism

Weinstein¹,

Epstein²

2011

Vitamin D

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Section: Anticonvulsantscontrasting

confidence: 54%

Section: Anticonvulsantsmentioning

confidence: 99%

Drug and Hormone Effects on Vitamin D Metabolism

Weinstein¹,

Epstein²

2011

Vitamin D

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“…Hannan et al (2008) showed that serum 25-hydroxyvitamin D and BMD were significantly related to one another in white men only. Mikati et al (2006) conducted the only randomized, controlled trial that demonstrated no significant difference between high-and low-dose vitamin D treatments, and no change in BMD compared with healthy controls after one year of treatment. Although there is no consensus on optimal vitamin D levels, many physicians often rely on 25-hydroxyvitamin D levels to evaluate bone health.…”

Section: Discussionmentioning

confidence: 99%

Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: A meta-analysis

Zhang

Zheng

Zhu

et al. 2015

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The aim of our meta-analysis was to assess the effects of antiepileptic drugs on bone mineral density and bone metabolism in epileptic children. Methods: Searches of PubMed and Web of Science were undertaken to identify studies evaluating the association between antiepileptic drugs and bone mineral density and bone metabolism. Results: A total of 22 studies with 1492 subjects were included in our research. We identified: (1) a reduction in bone mineral density at lumbar spine (standardized mean difference ( Our meta-analysis suggests that treatment with antiepileptic drugs may be associated with decreased bone mineral density in epileptic children.

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“…IU per day for adults and 2000 IU per day for children)[46, Class II]. In the adults, the baseline BMD was reduced at all sites when compared with controls matched for age and gender.…”

mentioning

confidence: 99%

Treatment of Epilepsy to Optimize Bone Health

Pack

2011

Curr Treat Options Neurol

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When treating a person with epilepsy, one must consider many factors in addition to the obvious need to treat the seizures. Both epilepsy itself and treatment with antiepileptic drugs (AEDs) subject one to numerous potential secondary long-term health concerns. Poor bone health is one of these concerns. Studies suggest that persons with epilepsy treated with AEDs have an increased risk of fracture, low bone mineral density (BMD), and abnormalities in bone metabolism. Multiple factors likely contribute to the increased risk. Falls during generalized tonic-clonic seizures, secondary effects of AEDs on balance, inactivity, low BMD, reduced calcium intake, reduced active vitamin D metabolites, and a genetic predisposition to low BMD may all contribute. Studies suggest a differential influence of AEDs. Phenytoin, phenobarbital, and primidone are most consistently associated with a negative impact on bone. Carbamazepine and valproate may also result in bone abnormalities, but data are mixed. Current studies suggest that lamotrigine has limited (if any) effect, but again, data are inconsistent. Other AEDs have received limited study. Screening for poor bone health includes serologic testing of vitamin D metabolites (notably 25-hydroxyvitamin D) as well as BMD testing using dual energy x-ray absorptiometry. Optimizing intake of calcium and vitamin D is important for all persons with epilepsy treated with AEDs. Although many treatments for low BMD are available, these agents have not been studied in persons with epilepsy treated with AEDs. Overall, physicians treating persons with epilepsy must consider the potential effect of having epilepsy and its main treatment, AED therapy, on bone health. For patients in whom bone health is a particular concern (eg, those with diagnosed bone disease or with significant risk factors for bone disease, including glucocorticosteroid use), it is best to avoid AEDs known to negatively affect bone. In addition, practitioners should work with other treating physicians to optimize bone health in these patients.

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Two randomized vitamin D trials in ambulatory patients on anticonvulsants

Abstract: In ambulatory adults on antiepileptic drugs, high-dose vitamin D therapy substantially increased bone mineral density at several skeletal sites. In children, both doses resulted in comparable increases in bone mass.

Cited by 119 publications

References 25 publications

Drug and Hormone Effects on Vitamin D Metabolism

Drug and Hormone Effects on Vitamin D Metabolism

Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: A meta-analysis

Treatment of Epilepsy to Optimize Bone Health

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