A 6-month longitudinal study of bone mineral density with antiepileptic drug monotherapy

Kim, Sook Hui; Lee, Jin Wha; Choi, Kyoung Gyu; Chung, Hye Won; Lee, Hyang Woon

doi:10.1016/j.yebeh.2006.11.007

Cited by 124 publications

(101 citation statements)

References 35 publications

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“…This currently seems to be in agreement with the results obtained by Kim Lee et al 27 in 2007. In their prospective study of eight newly-diagnosed epileptic patients, the authors reported that LTG monotherapy for a six-month duration resulted in no abnormalities in bone mineral density, calcium, phosphate, vitamin D and urinary deoxypyridinoline levels.…”

supporting

confidence: 93%

“…LTG n = 12 LEV n = 12 VPA + LTG n = 12 VPA + LEV n = 12 bone metabolism, inducing the development of parathyroid hormone resistance and compensating for bone loss through increasing bone formation 27,31 . In our study, both patients on LEV polytherapy (LEV+VPA combination) and those on LTG polytherapy (LTG+VPA combination) showed a negative effect on bone.…”

Section: Parameters/ Groupsmentioning

confidence: 99%

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Levetiracetam and lamotrigine effects as mono- and polytherapy on bone mineral density in epileptic patients

El-Haggar

Mostafa

Allah

et al. 2018

Arq. Neuro-Psiquiatr.

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The purpose of this study was to determine the effect of lamotrigine (LTG) and levetiracetam (LEV) as mono- and polytherapy on biochemical markers of bone turnover and bone mineral density in Egyptian adult patients with epilepsy. Methods Forty-eight patients were divided into four groups: two received monotherapy of either LTG or LEV, and the other two groups received polytherapy comprising (valproate [VPA] + LTG or VPA + LEV). Thirty matched healthy participants were included in the study. Participants completed a nutritional and physical activity questionnaire. Biochemical markers of bone and mineral metabolism and bone mineral density of the lumbar spine were measured at baseline and at six months. Results In the LEV monotherapy group, the bone formation markers showed a significant decrease in serum alkaline phosphatase and serum osteocalcin levels while the bone resorption marker showed a significant increase in urinary deoxypyridinoline levels. After six months of treatment, bone mineral density showed a significant decrease in all treated groups, while among monotherapy groups, this significant decrease was more prevalent in the LEV monotherapy group compared with the LTG monotherapy group. Furthermore, there was significant negative correlation between urinary deoxypyridinoline levels and bone mineral density in the LEV monotherapy group. Conclusion Using new generation antiepileptics, LEV monotherapies and polytherapy showed harmful effects on bone but LTG did not.

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supporting

confidence: 93%

Section: Parameters/ Groupsmentioning

confidence: 99%

Levetiracetam and lamotrigine effects as mono- and polytherapy on bone mineral density in epileptic patients

El-Haggar

Mostafa

Allah

et al. 2018

Arq. Neuro-Psiquiatr.

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“…Three prior prospective studies 5,10,21 examined AED use and rates of bone loss, but were limited by small sample size, selection bias, absence of a comparison group of subjects not taking AEDs, and lack of adjustment for potential confounders. A prior analysis 22 from the Study of Osteoporotic Fractures (SOF), a prospective study of a large cohort of older community-dwelling women similar in design to MrOS, reported that phenytoin users had higher adjusted rates of hip bone loss compared with nonusers of AEDs.…”

Section: Resultsmentioning

confidence: 99%

“…2 Evidence linking phenytoin (EIAED) [3][4][5][6][7] and phenobarbital (EIAED) 4,5 to lower bone mineral density (BMD) is generally consistent with this theory. However, carbamazepine (EIAED) [6][7][8][9][10] has not been associated with lower BMD, while valproic acid (nonenzyme-inducing AED [NEIAED]) 3,7-9 has been associated with lower BMD. Thus, multiple mechanisms underlying AEDrelated bone loss appear to exist, and all types of AED are potentially implicated.…”

mentioning

confidence: 99%

Antiepileptic drug use and rates of hip bone loss in older men

Ensrud¹,

et al. 2008

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Objective: To test the hypotheses that older community dwelling men taking non-enzymeinducing antiepileptic drugs (NEIAEDs) and those taking enzyme-inducing antiepileptic drugs (EIAEDs) have increased rates of hip bone loss. Methods:We ascertained antiepileptic drug (AED) use (interviewer-administered questionnaire with verification of use by containers) and measured hip bone mineral density (BMD) (using dual energy x-ray absorptiometry) at baseline and an average of 4.6 years later in a cohort of 4,222 older community-dwelling men enrolled in the Osteoporotic Fractures in Men study. Men were categorized as nonusers (no AED use at either examination, n ϭ 4060), NEIAED user (use of NEIAED only at either examination, n ϭ 100), or EIAED user (use of EIAED only at either examination, n ϭ 62). Results:After adjustment for multiple potential confounders (age, race, clinic site, health status, pain interfering with work or activity, physical activity, smoking status, alcohol use, total calcium intake, diabetes, chronic kidney disease, vitamin D supplement use, bisphosphonate use, selective serotonin reuptake inhibitor use, inability to rise from a chair, body mass index, and baseline BMD), the average rate of decline in total hip BMD was Ϫ0.35%/year among nonusers compared with Ϫ0.53%/year among NEIAED users (p ϭ 0.04) and Ϫ0.46%/year among EIAED users (p ϭ 0.31). Multivariable adjusted rate of loss was Ϫ0.60%/year among men taking NEIAED at both examinations, Ϫ0.51%/year among men taking NEIAED at one examination only, and Ϫ0.35%/ year among nonusers (p for trend ϭ 0.03). Findings were similar at hip subregions. Conclusion:Use of non-enzyme-inducing antiepileptic drugs was independently associated with increased rates of hip bone loss in this cohort of older community-dwelling men. Antiepileptic drug (AED) use may be associated with higher rates of bone loss because AED use may have adverse effects on bone metabolism. 1 On the other hand, AED use may be a marker of factors such as poor health, medical conditions, lifestyle behaviors, and neuromuscular impairments that are associated with greater rates of bone loss. Thus, an apparent association between AED use and bone loss might be due to these confounding factors rather than an effect of AED use.

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“…[1][2][3][4] These patients are also at high risk for pathological fractures due to reduction in the bone mineral density. These EIAED's which include phenytoin, carbamazepine, primidone, phenobarbitone and benzodiazepines cause decrease in bone mineral density by hepatic induction of cytochrome P450 enzymes leading to increased metabolism of vitamin D. 5 LEV was approved as one of the broad spectrum AEDs with good efficacy and safety in various types of epilepsies. 6,7 The effect of LEV on vitamin D and bone mineral density is unclear.…”

Section: Introductionmentioning

confidence: 99%

Levetiracetam monotherapy effect on serum calcium and serum vitamin D in patient of epilepsy

et al. 2017

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INTRODUCTIONIn patients with epilepsy, chronic therapy with conventional enzyme inducing antiepileptic drugs (EIAED's) causes abnormalities in calcium metabolism. These including hypocalcaemia, hypophosphatemia, elevated levels of serum alkaline phosphatase, serum parathyroid hormone and reduced serum levels of biologically active vitamin D metabolites. These changes cause radiologic evidence of rickets, and histological evidence of osteomalacia. [1][2][3][4] These patients are also at high risk for pathological fractures due to reduction in the bone mineral density. These EIAED's which include phenytoin, carbamazepine, primidone, phenobarbitone and benzodiazepines cause decrease in bone mineral density by hepatic induction of cytochrome P450 enzymes ABSTRACT Background: Objective of the study was to determine the Levetiracetam monotherapy effect on serum calcium and serum vitamin D levels in tertiary care hospital in Haryana, India. Methods: A total of 110 patients with epilepsy, were enrolled to the study for one year between April 2013 to August 2014. All male patients aged 15-60 years and premenopausal females with epilepsy were included in the study. The study was a interventional prospective study design. The antiepileptic drug levetiracetam was administered starting from a dose of 20 mg/kg and dose was titrated according to the clinical response. During the follow up period, the subjects were asked about the seizure frequency and other side effects. The patients were be subjected to questionnaires based proforma. Baseline investigations, Hemogram, renal and liver function tests, calcium, phosphate, vitamin D and bone mineral density and T scores were noted. All investigations were repeated after one year of levetiracetam monotherapy. Results: The mean age of onset of seizures in the study group was 23.22±6.62 years. 58% (n=29) were seizure free after 1 year of levetiracetam monotherapy, 28% patients had adequate control and 14% patients had poor control of their seizure episodes. There was an insignificant change in Hemoglobin, total leukocyte count, platelet count, renal parameters and Liver enzymes from baseline over a year of levetiracetam therapy. Serum calcium levels increased insignificantly from baseline levels of 9.68±0.59 mg/dl to 9.72±0.56mg/dl. Vitamin D levels increased from baseline of 39.35±14.91ng/ml to 39.84±14.07 ng/ml. Bone mineral density increased insignificantly from baseline of 0.92±0.13 g/cm 2 to 0.93±0.13 g/cm 2 . Conclusions: Present study has shown an overall beneficial effect on serum calcium, Vitamin D level, bone mineral density and T scores on DEXA scan.

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A 6-month longitudinal study of bone mineral density with antiepileptic drug monotherapy

Cited by 124 publications

References 35 publications

Levetiracetam and lamotrigine effects as mono- and polytherapy on bone mineral density in epileptic patients

Levetiracetam and lamotrigine effects as mono- and polytherapy on bone mineral density in epileptic patients

Antiepileptic drug use and rates of hip bone loss in older men

Levetiracetam monotherapy effect on serum calcium and serum vitamin D in patient of epilepsy

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