1
|
Parveen B, Penumallu NR, Shaik AR, Parveen A, Parveen R, Vohora D. The impact of antiseizure medication on bone heath: A systematic review of animal studies. Epilepsy Res 2024; 200:107302. [PMID: 38280331 DOI: 10.1016/j.eplepsyres.2024.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Antiseizure medications (ASMs) are known to potentially impact bone health, but existing literature presents conflicting results regarding their specific effects on bone mineralization, metabolism, and quality. OBJECTIVE This systematic review aims to establish a consensus regarding the influence of ASMs on bone health based on existing preclinical studies. METHODS Following SYRCLE and PRISMA guidelines, we conducted a systematic search in PubMed, Science Direct, and Google Scholar to identify relevant studies. Ultimately, 21 articles were selected for inclusion in this review. RESULTS Among the chosen studies, approximately half involved Wistar rats as experimental subjects. Levetiracetam and sodium valproate were the most frequently investigated drugs, with a typical treatment duration of 10-12 weeks. These studies exhibited a low risk of bias in aspects like sequence generation, random housing, random outcome assessment, and reporting bias. However, blinding in performance, allocation concealment, and detection were often rated as having a high risk of bias. The collective findings suggest that prolonged ASM use leads to reduced bone mineral density, altered bone turnover marker levels (including hypovitaminosis D, hypocalcemia, and secondary hyperparathyroidism), deterioration of bone microarchitecture, and decreased mechanical strength. CONCLUSION The adverse effects on bone associated with ASMs are not limited to enzyme-inducing drugs, as newer generation ASMs may also contribute to these effects. Hypovitaminosis D alone may not be solely responsible for ASM-induced bone issues, suggesting the involvement of other mechanisms. Furthermore, substantial variations were observed in the results of different preclinical studies on individual ASMs, highlighting the need to standardize animal study methodologies to enhance reproducibility and reduce variation.
Collapse
Affiliation(s)
- Bushra Parveen
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India; Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India.
| | - Naveen Reddy Penumallu
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India; Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Abdul Rahaman Shaik
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Abida Parveen
- Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rabea Parveen
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Divya Vohora
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India.
| |
Collapse
|
2
|
DeShazo SJ, Ozmer GL, Horton KA, Weiss WM. Phenytoin is associated with increased risk of osteoporosis and fragility fractures in adult epileptic patients. J Bone Miner Metab 2024; 42:69-76. [PMID: 38060024 DOI: 10.1007/s00774-023-01475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Osteoporotic fractures lead to significant decreases in the quality of life with increases in morbidity, mortality, and disability. Treatment with a variety of anti-epileptic drugs, such as phenytoin, has been understood to cause a decrease in bone mineral density. MATERIALS AND METHODS Cohort A was identified as patients that were 18-55 years old that had epilepsy and recurrent seizures that were also prescribed phenytoin. Cohort B was identified as patients that were 18-55 years old that had epilepsy and recurrent seizures but were not prescribed phenytoin or other anti-epileptic medications. Cohorts were matched for relevant confounding pathologies and demographic factors. Outcomes were evaluated from 1 day to 5 years after the indexed event. RESULTS A total of 35,936 patients with epilepsy that were prescribed phenytoin were matched with 109,335 patients with epilepsy that were not prescribed phenytoin. Patients on phenytoin therapy were at significantly higher risk for osteoporosis without pathological fracture, fracture of metatarsal bone, fracture of shoulder and upper arm, fracture of distal radius, fracture of thoracic vertebra, fracture of cervical vertebra, fracture of lumbar vertebra, fracture of femoral head or neck, pertrochanteric fracture, femoral shaft fracture, and distal tibia fracture (all outcomes p < 0.001). CONCLUSION Epileptic patients on phenytoin therapy that were 18-55 years old exhibited higher associated risk of osteoporosis and osteoporotic-fragility fractures of various regions. Patients that undergo phenytoin therapy for epilepsy treatment should be educated on the increased risk of bone fractures and have appropriate lifestyle and diet modifications.
Collapse
Affiliation(s)
- Sterling J DeShazo
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Garett L Ozmer
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Kyle A Horton
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - William M Weiss
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0165, USA
| |
Collapse
|
3
|
Investigation of the effect of anti-epileptic drugs on bone metabolism using osteoprotegerin and bone-specific alkaline phosphatase: The direct effects of antiepileptic drugs on bone metabolism. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.958297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
4
|
Guo Y, Lin Z, Huang Y, Yu L. Effects of valproate, lamotrigine, and levetiracetam monotherapy on bone health in newly diagnosed adult patients with epilepsy. Epilepsy Behav 2020; 113:107489. [PMID: 33220583 DOI: 10.1016/j.yebeh.2020.107489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of valproate (VPA), lamotrigine (LTG), and levetiracetam (LEV) on bone turnover and bone mineral density (BMD) in newly diagnosed adult patients with epilepsy. METHODS Eligible adult patients who were newly diagnosed with epilepsy were treated with VPA, LTG, and LEV. The chemical indicators of bone metabolism and BMD were measured before treatment and 2 years after treatment with different antiseizure medication (ASM) monotherapies. Then, the differences in these parameters before and after treatment were analyzed. RESULTS One hundred twenty-four patients completed the 2 years follow-up; 43 received monotherapy with VPA, 32 received LTG, and 49 received LEV. Serum parathyroid hormone (PTH), bone alkaline phosphatase (B-ALP), and β-cross-linked C-telopeptide of type I collagen (β-CTX) levels were elevated in adult patients after 2 years of VPA administration; the serum procollagen I intact N-terminal peptide (PINP) level was noticeably higher in patients after LEV treatment than before treatment. Meanwhile, the BMD of the lumbar spine and femoral neck did not change in patients treated with VPA, LTG, and LEV. CONCLUSIONS Valproate altered bone turnover in adult patients with epilepsy, while LTG and LEV did not exert harmful effects on bone health in adult patients.
Collapse
Affiliation(s)
- Yi Guo
- Department of Neurology, The Sixth People's Hospital of Chengdu, No. 16 South Jianshe Road, Chengdu, Sichuan 610051, People's Republic of China
| | - Zhonghua Lin
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China
| | - Yulan Huang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China.
| | - Liang Yu
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China.
| |
Collapse
|
5
|
Siniscalchi A, Murphy S, Cione E, Piro L, Sarro GD, Gallelli L. Antiepileptic Drugs and Bone Health: Current Concepts. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:36-44. [PMID: 32508365 PMCID: PMC7255839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chronic use of antiepileptic drugs (AEDs) can induce the development of adverse effects on bone metabolism. In epileptic patients treated with AED, the monitoring of biochemical markers of bone turnover, such as the measurement of serum 25 (OH) vitamin D, bone mineral density, before the beginning of the treatment and during the follow-up is not routinely required. In the future, monitoring of biochemical markers in epileptic patients treated with AED may help us for adequate prevention therapy.
Collapse
Affiliation(s)
- Antonio Siniscalchi
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Sean Murphy
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Erika Cione
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Leonardo Piro
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Giovambattista De Sarro
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Luca Gallelli
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| |
Collapse
|
6
|
Simko J, Karesova I, Kremlacek J, Eva Z, Horacek J, Fekete S, Malakova J, Zivna H, Palicka V. The effect of gabapentin and pregabalin on bone turnover and bone strength: A prospective study in Wistar rats. Pharmacol Rep 2019; 71:1213-1218. [PMID: 31669885 DOI: 10.1016/j.pharep.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited data on the effects of GBP on bone and no data for PGB. Some data suggest that there is a significant influence of sex hormone balance on the susceptibility of bone to antiepileptic drug-induced bone loss. METHODS Forty-eight male Wistar rats were divided into six groups that were subjected to two surgeries, sham (noORX) or real orchidectomy (ORX), and were fed three diets, a SLD, a SLD enriched with GBP or a SLD enriched with PGB. Dual energy X-ray absorptiometry was used to measure the bone mineral density. The concentrations of bone turnover markers were assayed. The femurs were biomechanically tested. RESULTS Significant reductions in bone mineral density, weight and biomechanical strength were observed in ORX animals. GBP or PGB exposure did not cause significant alterations in bone mineral density or biomechanical strength. No changes in bone turnover markers were observed, except for RANKL. A significant increase was found in the ORX GBP and ORX PGB groups. Within the orchidectomized animal group, RANKL levels were significantly higher in the ORX PGB group than in the ORX GBP group. CONCLUSIONS Because neither GBP nor PGB affected bone mineral density or mechanical bone strength, both of these antiepileptic drugs could be considered drugs with lower risks to bone health. A shift in RANKL levels indicates that the effects of GBP and PGB on osteoclast activity may be dependent on the hormonal status of animals.
Collapse
Affiliation(s)
- Julius Simko
- Department of Neurology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic.
| | - Iva Karesova
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jan Kremlacek
- Department of Pathophysiology, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Zimcikova Eva
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Jiri Horacek
- Department of Internal Medicine - Hematology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Sona Fekete
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jana Malakova
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Helena Zivna
- Radioisotope Laboratories and Vivarium, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Vladimir Palicka
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| |
Collapse
|
7
|
Diemar SS, Sejling AS, Eiken P, Andersen NB, Jørgensen NR. An explorative literature review of the multifactorial causes of osteoporosis in epilepsy. Epilepsy Behav 2019; 100:106511. [PMID: 31522076 DOI: 10.1016/j.yebeh.2019.106511] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients with epilepsy have a greatly increased risk of osteoporosis and fractures. The literature is diverse and contradictory when dealing with the underlying pathophysiological mechanisms. Consequently, the purpose of this review was to shed light on the multifactorial causes behind the increased occurrence of metabolic bone disease in patients with epilepsy and to identify areas for future research. METHODS A review of the literature was performed searching PubMed with relevant Medical Subject Headings MeSH terms. The results of the search were evaluated for relevance to the review based on the title and abstract of the publication. Publications in language other than English and publications pertaining only pediatric patients were excluded. For all studies, included reference lists were evaluated for further relevant publications. In total, 96 publications were included in this explorative review. RESULTS The high occurrence of metabolic bone disease in patients with epilepsy is multifactorial. The causes are the socioeconomic consequences of having a chronic neurological disease but also adverse effects to antiepileptic drug treatment ranging from interference with calcium and vitamin D metabolism to hyponatremia-induced osteoporosis. CONCLUSION The literature supports the need for awareness of bone health in patients with epilepsy. The pathophysiological mechanisms are many and various wanting for further research in the less well-characterized areas. Furthermore, great responsibility rests on the healthcare professionals in implementing comprehensive patient care and in assuring bone protective measures in clinical practice to prevent bone loss in patients with epilepsy.
Collapse
Affiliation(s)
- Sarah Seberg Diemar
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense C, Denmark.
| | - Anne-Sophie Sejling
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Pia Eiken
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Noémi Becser Andersen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
| | - Niklas Rye Jørgensen
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws vej 19, 5000 Odense C, Denmark; Department of Clinical Biochemistry, Rigshospitalet Glostrup, Valdemar Hansens vej 1-23, 2600 Glostrup, Denmark
| |
Collapse
|
8
|
Shawahna R. Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study. Epilepsy Behav 2017; 77:79-89. [PMID: 29127865 DOI: 10.1016/j.yebeh.2017.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to develop and achieve consensus on a core list of important knowledge items that community pharmacists should know on women's issues in epilepsy. METHODS This was a consensual study using a modified Delphi technique. Knowledge items were collected from the literature and from nine key contacts who were interviewed on their views on what information community pharmacists should have on women's issues in epilepsy. More knowledge items were suggested by five researchers with interest in women's issues who were contacted to rate and comment on the knowledge items collected. Two iterative Delphi rounds were conducted among a panel of pharmacists (n=30) to achieve consensus on the knowledge items to be included in the core list. Ten panelists ranked the knowledge items by their importance using the Analytical Hierarchy Process (AHP). RESULTS Consensus was achieved to include 68 knowledge under 13 categories in the final core list. Items ranked by their importance were related to the following: teratogenicity (10.3%), effect of pregnancy on epilepsy (7.4%), preconception counseling (10.3%), bone health (5.9%), catamenial epilepsy (7.4%), menopause and hormonal replacement therapy (2.9%), contraception (14.7%), menstrual disorders and infertility (8.8%), eclampsia (2.9%), breastfeeding (4.4%), folic acid and vitamin K (5.9%), counseling on general issues (14.7%), and sexuality (4.4%). CONCLUSION Using consensual knowledge lists might promote congruence in educating and/or training community pharmacists on women's issues in epilepsy. Future studies are needed to investigate if such lists can improve health services provided to women with epilepsy (WWE).
Collapse
Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW It is well-recognized that individuals with epilepsy have an increased risk of vertebral and nonvertebral fractures; this increased risk has been described to be secondary to an increased bone fragility and to an increased risk of falls. Osteoporosis is the most common bone disease which has been characterized by microarchitectural deterioration of trabecula and cortical bone mass with a decrease in bone mineral density and bone strength. Specific side effects of antiepileptic drugs (AEDs) on bone metabolism have been identified; recent research publications further characterized some of the specific side effects of AEDs on bone metabolism. It is the purpose of this review to describe recent advances on the knowledge of the effects of AEDs on bone metabolism and the cause of osteoporosis in the field of epilepsy. RECENT FINDINGS Recent literature demonstrates that the increased risk of fractures in the epileptic patient population is likely multifactorial and includes seizure activity, injuries from falls, decreased bone strength, adverse effects from AEDs. Reviewed publications suggest that the mechanism of adverse effects on bone metabolism may differ among different AEDs. The impact of vitamin D deficiency or its metabolism in the epileptic population has also been a concern of several reviewed publications. SUMMARY This is a review is of the recent epilepsy and osteoporosis literature published over the past 18 months, highlighting reports and studies concerning the cause, pathogenesis, and possible preventive measures and effects of AEDs on changes of bone metabolism, bone loss, and development of osteoporosis. In addition, we also reviewed articles focusing on issues of prevention and treatment of osteoporosis in individuals with epilepsy. We utilized the search engines of PubMed and Cochrane Reviews from January 2016 to June 2017.
Collapse
Affiliation(s)
- Philip M Dussault
- aVA Boston Healthcare System bVA Boston Health Care System and Boston University School of Medicine and Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|