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Jiang X, Xiong F, Wu S, Hong L, Lin Z, Lin Z, Huang X. Effects of levetiracetam on bone mineral density and bone metabolism in patients with epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2024; 158:109925. [PMID: 38959743 DOI: 10.1016/j.yebeh.2024.109925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE The effects of levetiracetam (LEV) on bone mineral density (BMD) and bone metabolism are currently inconclusive, and this study was designed to answer this question. METHODS Citations from PubMed, Embase, Cochrane Library, and Web of Science databases (up to February 4, 2024) were reviewed. The effects of LEV on BMD as well as bone metabolism indicators were measured by calculating the standardized mean difference (SMD) with a 95% confidence interval (CI). This study was registered with PROSPERO (CRD42024509560). RESULTS A total of 612 individuals from 13 studies were included in the present analysis. Of the items related to bone metabolism, LEV was found to be associated significantly with decreased serum calcium with an SMD of -0.47 (95 % CI, -0.77- -0.16; p = 0.04). However, changes in other markers (including serum phosphorus, 25-hydroxyvitamin D, alkaline phosphatase, and parathyroid hormone) were not statistically significantly correlated with the use of LEV (p > 0.05). Also, when compared to the control groups, the changes in BMD of the observation groups were not significant (p > 0.05). CONCLUSIONS The use of LEV may significantly reduce serum calcium in patients with epilepsy, and regular monitoring of bone metabolism-related indicators is recommended.
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Affiliation(s)
- Xuehui Jiang
- Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Fangfang Xiong
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China
| | - Shuifa Wu
- Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Lei Hong
- Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Zhiqiang Lin
- Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - Zhihang Lin
- Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China.
| | - Xiaowei Huang
- Department of Pharmacy, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China.
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Feng B, Lu J, Han Y, Han Y, Qiu X, Zeng Z. The role of short-chain fatty acids in the regulation of osteoporosis: new perspectives from gut microbiota to bone health: A review. Medicine (Baltimore) 2024; 103:e39471. [PMID: 39183408 PMCID: PMC11346881 DOI: 10.1097/md.0000000000039471] [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: 01/27/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024] Open
Abstract
Osteoporosis is a systemic skeletal disease characterized by low bone density and microarchitectural deterioration, resulting in increased fracture risk. With an aging population, osteoporosis imposes a heavy burden worldwide. Current pharmacotherapies such as bisphosphonates can reduce fracture risk but have limitations. Emerging research suggests that gut microbiota regulates bone metabolism through multiple mechanisms. Short-chain fatty acids (SCFAs) produced from microbial fermentation of dietary fiber beneficially impact bone health. Preclinical studies indicate that SCFAs such as butyrate and propionate prevent bone loss in osteoporosis models by inhibiting osteoclastogenesis and immune modulation. Early clinical data also suggest that SCFA supplementation may improve bone turnover markers in postmenopausal women. SCFAs likely act via inhibition of osteoclast differentiation, stimulation of osteoblast activity, regulation of T cells, and other pathways. However, optimal dosing, delivery methods, and long-term safety require further investigation. Modulating the gut-bone axis via supplementation, prebiotics/probiotics, diet, and lifestyle interventions represents an innovative therapeutic approach for osteoporosis. Harnessing the interplay between microbiome, metabolism, immunity, and bone may provide new directions for managing osteoporosis in the future.
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Affiliation(s)
- Boyi Feng
- Shenzhen Guangming District People’s Hospital, Shenzhen, China
| | - Jingjing Lu
- Shenzhen Guangming District People’s Hospital, Shenzhen, China
| | - Yanhua Han
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yaguang Han
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaokui Qiu
- Shenzhen Guangming District People’s Hospital, Shenzhen, China
| | - Zhuoying Zeng
- Chemical Analysis and Physical Testing Institute, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Tao ZS, Hu XF, Sun T. Melatonin prevents bone loss in osteoporotic rats with valproic acid treatment by anti-inflammatory and anti-oxidative stress. Int Immunopharmacol 2024; 141:112932. [PMID: 39154533 DOI: 10.1016/j.intimp.2024.112932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/27/2024] [Accepted: 08/11/2024] [Indexed: 08/20/2024]
Abstract
Melatonin (MEL) has shown positive effects in anti-inflammatory and anti-oxidative stress research. This study investigates whether MEL can positively impact bone loss induced by valproic acid (VPA) in rats. The study examines changes in MC3T3-E1 cell viability and osteogenic potential, along with osteoclast differentiation in RAW264.7 cells in the presence of VPA using CCK-8, ALP staining, AR staining, and TRAP staining. In vitro experiments reveal that VPA-induced inhibition of osteogenic differentiation and promotion of osteoclastic differentiation are linked to increased inflammation and oxidative stress. Furthermore, MEL has demonstrated the ability to reduce oxidative stress and inflammation, boost osteogenic differentiation, and inhibit osteoclast differentiation. Animal experiments confirm that MEL significantly increases SOD2 expression and decreases TNF-α expression, leading to the restoration of impaired bone metabolism, enhanced bone strength, and higher bone mineral density. The combined experimental results strongly suggest that MEL can enhance osteogenic activity in the presence of VPA by reducing inflammation and oxidative stress, impeding osteoclast differentiation, and alleviating bone loss in VPA-treated rat models.
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Affiliation(s)
- Zhou-Shan Tao
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, No. 2, Zhe Shan Xi Road, Wuhu 241001, Anhui, PR China; Anhui Province Key Laboratory of Non-coding RNA Basic and Clinical Transformation, No. 2, Zhe Shan Xi Road, Wuhu 241001, Anhui, PR China
| | - Xu-Feng Hu
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, No. 2, Zhe Shan Xi Road, Wuhu 241001, Anhui, PR China
| | - Tao Sun
- Department of Orthopedics, Lishui Central Hospital, the Fifth Affiliated Hospital of Wenzhou Medical University, No. 289, Kuocang Road, Lishui City 323000, ZheJiang, PR China.
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Xie X, Cheng P, Hu L, Zhou W, Zhang D, Knoedler S, Liu G, Xiong Y, Xue H, Hu Y, Kern B, Obed D, Panayi AC, Chen L, Yan C, Lin Z, Dai G, Mi B, Zhang Y, Liu G. Bone-targeting engineered small extracellular vesicles carrying anti-miR-6359-CGGGAGC prevent valproic acid-induced bone loss. Signal Transduct Target Ther 2024; 9:24. [PMID: 38246920 PMCID: PMC10800355 DOI: 10.1038/s41392-023-01726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/31/2023] [Accepted: 12/10/2023] [Indexed: 01/23/2024] Open
Abstract
The clinical role and underlying mechanisms of valproic acid (VPA) on bone homeostasis remain controversial. Herein, we confirmed that VPA treatment was associated with decreased bone mass and bone mineral density (BMD) in both patients and mice. This effect was attributed to VPA-induced elevation in osteoclast formation and activity. Through RNA-sequencing, we observed a significant rise in precursor miR-6359 expression in VPA-treated osteoclast precursors in vitro, and further, a marked upregulation of mature miR-6359 (miR-6359) in vivo was demonstrated using quantitative real-time PCR (qRT-PCR) and miR-6359 fluorescent in situ hybridization (miR-6359-FISH). Specifically, the miR-6359 was predominantly increased in osteoclast precursors and macrophages but not in neutrophils, T lymphocytes, monocytes and bone marrow-derived mesenchymal stem cells (BMSCs) following VPA stimulation, which influenced osteoclast differentiation and bone-resorptive activity. Additionally, VPA-induced miR-6359 enrichment in osteoclast precursors enhanced reactive oxygen species (ROS) production by silencing the SIRT3 protein expression, followed by activation of the MAPK signaling pathway, which enhanced osteoclast formation and activity, thereby accelerating bone loss. Currently, there are no medications that can effectively treat VPA-induced bone loss. Therefore, we constructed engineered small extracellular vesicles (E-sEVs) targeting osteoclast precursors in bone and naturally carrying anti-miR-6359 by introducing of EXOmotif (CGGGAGC) in the 3'-end of the anti-miR-6359 sequence. We confirmed that the E-sEVs exhibited decent bone/osteoclast precursor targeting and exerted protective therapeutic effects on VPA-induced bone loss, but not on ovariectomy (OVX) and glucocorticoid-induced osteoporotic models, deepening our understanding of the underlying mechanism and treatment strategies for VPA-induced bone loss.
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Affiliation(s)
- Xudong Xie
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Peng Cheng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Liangcong Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Wu Zhou
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Detai Zhang
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, P.R. China
| | - Samuel Knoedler
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02152, USA
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Guodong Liu
- Medical Center of Trauma and War Injuries, Daping Hospital, Army Medical University, Chonqing, 400042, China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Hang Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Yiqiang Hu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Barbara Kern
- Department of Plastic Surgery, Campus Charité Mitte|Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Doha Obed
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02152, USA
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Adriana C Panayi
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02152, USA
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen/Rhine, Germany
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Chenchen Yan
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Ze Lin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China
| | - Guandong Dai
- Pingshan District People's Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, Guangdong, 518118, China
| | - Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China.
| | - Yingze Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022, China.
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Shi XY, Ju J, Lu Q, Hu LY, Tian YP, Guo GH, Liu ZS, Wu GF, Zhu HM, Zhang YQ, Li D, Gao L, Yang L, Wang CY, Liao JX, Wang JW, Zhou SZ, Wang H, Li XJ, Gao JY, Zhang L, Shu XM, Li D, Li Y, Chen CH, Zhang XJ, Zhong JM, Zhai QX, Sun YH, Lin XF, Ren RN, Yin F, Chen YH, Jia FY, Yang ZX, Wang JL, Xia ZZ, Wang LW, Luo R, Zou LP. Both epilepsy and anti-seizure medications affect bone metabolism in children with self-limited epilepsy with centrotemporal spikes. Epilepsia 2023; 64:2667-2678. [PMID: 37522416 DOI: 10.1111/epi.17733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Bone metabolism can be influenced by a range of factors. We selected children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and lifestyles similar to those of healthy children to control for the confounding factors that may influence bone metabolism. We aimed to identify the specific effects of epilepsy and/or anti-seizure medications (ASMs) on bone metabolism. METHODS Patients with SeLECTS were divided into an untreated group and a monotherapy group, and the third group was a healthy control group. We determined the levels of various biochemical markers of bone metabolism, including procollagen type I nitrogenous propeptide (PINP), alkaline phosphatase (ALP), osteocalcin (OC), collagen type I cross-linked C-telopeptide (CTX), calcium, magnesium, phosphorus, parathyroid hormone (PTH), and vitamin D3 (VD3 ). RESULTS A total of 1487 patients (from 19 centers) were diagnosed with SeLECTS; 1032 were analyzed, including 117 patients who did not receive any ASMs (untreated group), 643 patients who received only one ASM (monotherapy group), and 272 children in the healthy control group. Except for VD3 , other bone metabolism of the three groups were different (p < .001). Bone metabolism was significantly lower in the untreated group than the healthy control group (p < .05). There were significant differences between the monotherapy and healthy control group in the level of many markers. However, when comparing the monotherapy and untreated groups, the results were different; oxcarbazepine, levetiracetam, and topiramate had no significant effect on bone metabolism. Phosphorus and magnesium were significantly lower in the valproic acid group than the untreated group (adjusted p < .05, Cliff's delta .282-.768). CTX was significantly higher in the lamotrigine group than in the untreated group (adjusted p = .012, Cliff's delta = .316). SIGNIFICANCE Epilepsy can affect many aspects of bone metabolism. After controlling epilepsy and other confounders that affect bone metabolism, we found that the effects of ASMs on bone metabolism differed. Oxcarbazepine, levetiracetam, and topiramate did not affect bone metabolism, and lamotrigine corrected some of the abnormal markers of bone metabolism in patients with epilepsy.
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Affiliation(s)
- Xiu-Yu Shi
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun Ju
- Department of Pediatrics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qian Lu
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin-Yan Hu
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ya-Ping Tian
- Research Center of Birth Defect Prevention Technology, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Guang-Hong Guo
- Department of Laboratory Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Sheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ge-Fei Wu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Hong-Min Zhu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yu-Qin Zhang
- Department of Neurology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Dong Li
- Department of Neurology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Li Gao
- Department of Pediatrics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Liu Yang
- Department of Pediatrics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chun-Yu Wang
- Department of Neurology, Harbin Children's Hospital, Harbin, China
| | - Jian-Xiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Ji-Wen Wang
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shui-Zhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Hua Wang
- Department of Pediatric Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Jing Li
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jing-Yun Gao
- Department of Pediatric Neurology, Hebei Tangshan City Maternal and Child Health Care Hospital, Tangshan, China
| | - Li Zhang
- Department of Pediatrics, Linyi People's Hospital, Linyi, China
| | - Xiao-Mei Shu
- Department of Pediatrics, Zunyi Medical College, Zunyi, China
| | - Dan Li
- Department of Pediatrics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Li
- Department of Neurology, Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Chun-Hong Chen
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiu-Ju Zhang
- Department of Pediatrics, Xingtai People's Hospital, Xingtai, China
| | - Jian-Min Zhong
- Department of Neurology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Qiong-Xiang Zhai
- Department of Pediatrics, Guangdong General Hospital, Guangzhou, China
| | - Yan-Hong Sun
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, China
| | - Xue-Feng Lin
- Department of Neurology, Quanzhou Children's Hospital, Quanzhou, China
| | - Rong-Na Ren
- Department of Pediatrics, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Hui Chen
- Department of Pediatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fei-Yong Jia
- Department of Development and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Zhi-Xian Yang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ju-Li Wang
- Department of Epilepsy, The Central Hospital of Jiamusi City, Jiamusi, China
| | - Zhe-Zhi Xia
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Wen Wang
- Department of Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li-Ping Zou
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
- Center for Brain Disorders Research, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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Di Lorenzo P, Casella C, Dei Medici S, Policino F, Capasso E, Niola M. Child Abuse: Adherence of Clinical Management to Guidelines for Diagnosis of Physical Maltreatment and Neglect in Emergency Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5145. [PMID: 36982056 PMCID: PMC10049689 DOI: 10.3390/ijerph20065145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Child maltreatment is a phenomenon of great importance due to the significant socio-health implications related to it. Purpose of the study is assessing compliance child abuse clinical management with guidelines and suggest corrective actions to avoid false negative or false positive judgments. The data come from 34 medical records of child victims of suspected abuse hospitalized in a pediatric clinic. We examined diagnostic and medico-legal management through the analysis of pediatric, dermatological, ophthalmological (including fundus examination), and gynecological (only in some cases) consultations, brain and skeletal imaging, laboratory tests (with reference to the study of hemostasis), and medico-legal advice. Of 34 patients, the average age was 23 months, ranging from 1 month to 8 years. The judgment was positive for abuse for 20 patients and negative for 12 patients; in two cases it was not possible to express a conclusive judgment. Two children died because of the injuries sustained. We underline the need of clinical-diagnostic standardized protocols, coroner in emergency settings, short-distance follow-up, social worker support. We also suggest objectifying in a descriptive way (using a common and repeatable language) and with photographic documentation the results of all the investigations carried out, to evaluate signs of physical maltreatment and neglect.
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LoPinto-Khoury C. Long-Term Effects of Antiseizure Medications. Semin Neurol 2022; 42:583-593. [PMID: 36216358 DOI: 10.1055/a-1958-0802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Most patients with epilepsy will benefit from seizure control with one of an array of chronic antiseizure medications. Knowledge of the potential long-term effects of these medications is critical to prevent adverse consequences on overall health. Antiseizure medications vary in their capacities to affect the brain and peripheral nerves, hormones, bone mineralization, cardiovascular risk, renal health, hepatic, hematological, and dermatological systems. Understanding of pathophysiology and population risk has evolved, although most of the data available are still on older generation antiseizure medications such as phenytoin, carbamazepine, and valproic acid. The enzyme-inducing properties of some antiseizure medications make their effects on cardiovascular risk and bone health detrimental. Few clear guidelines exist for monitoring long-term effects of medication therapy for epilepsy. When selecting an antiseizure medication, consideration should be given to the individual patient's risks of adverse consequences on other organ systems. During monitoring of patients on chronic therapy, screening tools such as metabolic panels and bone density measurements can help stratify risk and guide management.
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Affiliation(s)
- Carla LoPinto-Khoury
- Department of Neurology, Lewis Katz Temple School of Medicine, Philadelphia, Pennsylvania
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8
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Dong N, Guo HL, Hu YH, Yang J, Xu M, Ding L, Qiu JC, Jiang ZZ, Chen F, Lu XP, Li XN. Association between serum vitamin D status and the anti-seizure treatment in Chinese children with epilepsy. Front Nutr 2022; 9:968868. [PMID: 36105574 PMCID: PMC9464910 DOI: 10.3389/fnut.2022.968868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/10/2022] [Indexed: 01/10/2023] Open
Abstract
ObjectiveTo compare the serum 25-OH-VitD levels, the major marker of vitamin D (VitD) status, between healthy children and children with epilepsy before initiation of and during anti-seizure medications (ASMs) treatment and to evaluate the potential influence factors on 25-OH-VitD levels. Another major aim was to assess the potential role of VitD supplementation.MethodsFor comparison, we finally enrolled and collected data from 6,338 healthy children presenting to Health Care Department and 648 children visiting primary care pediatricians with symptoms of epilepsy in Children’s Hospital of Nanjing Medical University from January 2019 to June 2021. The demographic and biochemical characteristics of each child were extracted from the hospital information system.ResultsSerum 25-OH-VitD levels in 648 children with epilepsy were significantly lower than those of 6,338 healthy children (P < 0.0001), and the percentage of VitD insufficiency and deficiency status in pediatric patients was 49.19%. Of note, the serum 25-OH-VitD levels in children with newly diagnosed epilepsy before receiving any ASMs treatment were also significantly lower than those in healthy controls. Interestingly, ASMs therapy, alone or in combination, did not consistently reduce baseline serum VitD levels in children with epilepsy. The lower serum VitD levels in pediatric patients than those in healthy children might be related to the disease itself, rather than the ASMs treatment. As expected, VitD supplementation substantially increased the serum 25-OH-VitD levels (P < 0.0001). More critically, children with epilepsy receiving VitD supplementation achieved good seizure control in our study.SignificanceIn this retrospective study, the childhood epilepsy before initiation of and during ASMs treatment decreased the serum 25-OH-VitD concentrations, suggesting a clear association between epileptic disease and the risk of VitD deficiency. ASMs coadministration and long-term valproic acid treatment did not worse VitD-deficiency status, but in the small group receiving VitD supplementation, there was a significant improvement in reduction of seizure frequency. Therefore, pediatric clinicians are urged to raise public awareness of epilepsy-associated VitD deficiency.
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Affiliation(s)
- Na Dong
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Institute of Pharmaceutical Science, China Pharmaceutical University, Nanjing, China
| | - Hong-Li Guo
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jiao Yang
- Department of Information Science, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Min Xu
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Le Ding
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Chun Qiu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Zhou Jiang
- Institute of Pharmaceutical Science, China Pharmaceutical University, Nanjing, China
| | - Feng Chen
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Feng Chen,
| | - Xiao-Peng Lu
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Xiao-Peng Lu,
| | - Xiao-Nan Li
- Department of Children Health Care, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Xiao-Nan Li,
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de Filippis R, Mercurio M, Spina G, De Fazio P, Segura-Garcia C, Familiari F, Gasparini G, Galasso O. Antidepressants and Vertebral and Hip Risk Fracture: An Updated Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10050803. [PMID: 35627940 PMCID: PMC9140335 DOI: 10.3390/healthcare10050803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/14/2022] [Accepted: 04/23/2022] [Indexed: 12/10/2022] Open
Abstract
Although antidepressant drugs appear to play an active role in increasing fracture risk, their weight is still unclear. We conducted a PRISMA compliant systematic review and meta-analysis through PubMed/Scopus/Cochrane libraries and registered with PROSPERO (registration number CRD42021254006) to investigate the relationship between antidepressant drugs categories, including SSRIs, SNRIs, and TCAs, and the risk of hip and vertebral fractures. After screening 3122 items, we finally found 26 papers for qualitative analysis and 11 for quantitative synthesis. A total of 15,209,542 adult and elderly patients were identified, with a mean follow-up of 51 months and a major prevalence of women. We identified results largely for SSRIs, with only a small amount of data for SNRIs, TCAs, and NaSSA. No data were found among the most recent categories of antidepressants, such as vortioxetine and esketamine. All included studies reported hip fractures, while three of them also included vertebral fractures. Overall, we observed a significant effect of SSRIs on fracture risk with a mean effect of 0.98 (95% CI = 0.75–1.20). This meta-analysis reveals that the use of SSRIs increases the risk of fractures. Clinicians’ awareness in antidepressant prescription should optimize their potential while reducing this risk.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (R.d.F.); (P.D.F.)
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
- Correspondence: ; Tel.: +39-0961-3647122
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (R.d.F.); (P.D.F.)
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Mater Domini” University Hospital, V.le Europa (loc. Germaneto), “Magna Græcia” University, 88100 Catanzaro, Italy; (G.S.); (F.F.); (G.G.); (O.G.)
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Abstract
ABSTRACT The risk of bone fracture in children under proton-pump inhibitors (PPI) treatment has been the subject of recent publications and naturally raises concerns among prescribing doctors, patients and their parents.Currently, there is no consistency in those risk claims according to the available evidence and an update on it is beneficial to reduce anxiety on one hand, and prompt for well-planned studies addressing the issue on the other. Furthermore, common sense and well-founded prescriptions must be the general rule for this as for any other therapeutic drug.
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Affiliation(s)
- Marta Tavares
- Unit of Pediatric Gastroenterology, Centro Materno-Infanil do Norte
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Centro Hospitalar Universitário S. João, Porto, Portugal
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11
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Jouyban A, Farajzadeh MA, Afshar Mogaddam MR, Nemati M, Khoubnasabjafari M, Jouyban-Gharamaleki V. Molecularly imprinted polymer based-solid phase extraction combined with dispersive liquid–liquid microextraction using new deep eutectic solvent; selective extraction of valproic acid from exhaled breath condensate samples. Microchem J 2021. [DOI: 10.1016/j.microc.2020.105772] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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Zhang R, Yang M, Li Y, Liu H, Ren M, Tao ZS. Effect of alendronate on the femoral metaphyseal defect under carbamazepine in ovariectomized rats. J Orthop Surg Res 2021; 16:14. [PMID: 33407695 PMCID: PMC7788868 DOI: 10.1186/s13018-020-02151-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of antiepileptic drugs and estrogen deficiency put forward higher requirements for bone defect regeneration. The present study investigated the effects of alendronate (ALN) on femoral bone defect in ovariectomized (OVX) rats under the influence of carbamazepine (CBZ). METHODS One hundred female SD rats at 3 months of age were either sham-operated or OVX and divided into four groups: sham control (CON); OVX control (OVX); ovariectomized rats treated with CBZ via gavage (75 mg/kg/day; CBZ); ovariectomized rats treated with CBZ plus ALN (2 mg/kg/day; CBZ-ALN). A critical-sized femoral metaphyseal bone defect was established in all female SD rats. Animals from the CBZ and CBZ-ALN groups received drugs by gavage the day after bone defect surgery was performed. After the rats were sacrificed, the defected area located in the distal femur was harvested for evaluation by microcomputed tomography (micro-CT), hematoxylin and eosin (HE) staining, and Masson's trichrome staining. The samples were also analyzed by biomechanics and immunohistochemical evaluation (IHC). Besides, biochemical analysis evaluates all serum samples. RESULTS The present study showed that ovariectomy changed the microstructural parameters of bone. The use of CBZ further decreased femur bone mass while treatment with ALN prevented bone loss. Compared to OVX and CBZ groups, CBZ-ALN group promoted bone neoformation and enhanced the ultimate load of the femur bone. However, the group of CBZ-ALN did not return to normal levels compared with the CON group. Besides, we noticed that CBZ-ALN group reduced tartrate-resistant acid phosphatase-5b (Tracp-5b) expression and had no significant effect on the expression of osteocalcin (OCN) and type I collagen (Col-I) in IHC compared with CBZ group. Biochemical analysis results presented that systemic delivery of CBZ showed pernicious effects on bone formation and resorption in ovariectomized rats, with the worse effects on C-terminal crosslinked telopeptide of type I collagen (CTX-1). Besides, a significant decrease in CTX-1 levels was observed in CBZ-ALN group as compared to the group of CBZ. CONCLUSION These results demonstrated that ALN can effectively reverse the effects of CBZ on the microarchitectural properties of bone, and thus can have a positive effect on local bone neoformation in rats with osteoporosis. CLINICAL RELEVANCE The dose of 2 mg/kg ALN improves the negative effect of prescription of CBZ at 75 mg/kg and promotes bone neoformation of femoral bony deficits.
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Affiliation(s)
- Ruotian Zhang
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Min Yang
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China.
| | - Yang Li
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Hedong Liu
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Maoxian Ren
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Zhou-Shan Tao
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
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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.
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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.
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