Effect of antiepileptic medication on bone mineral measures

Abstract

Patients using AEDs for > 2 years, in particular those taking enzyme-inducing AEDs and those older than 40 years, have significantly lower bone mineral density at clinically relevant fracture risk sites.

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

“…AEDs increase catabolism of 25-hydroxyvitamin D by induction of the hepatic P-450 enzyme system, leading to relative hypocalcemia, increased levels of parathyroid hormone (PTH), and subsequent low BMD (Dent et al, 1970;Keck et al, 1982;Chung and Ahn, 1994). However, some studies have suggested a significant reduction in BMD with non-enzymeinducing AEDs (Oner et al, 2004;Petty et al, 2005). Other environmental and epidemiological parameters including age, sex, diet, and mobility may also affect mineral metabolism (Pack and Morrell, 2001), suggesting a multifactorial etiology.…”

The effect of anticonvulsant use on bone mineral density in non-ambulatory children with cerebral palsy

“…5 A study revealed that AED use was associated with reduced BMD in 35 pairs of twin adults, and the effect was more marked in those prescribed enzyme-inducing AEDs, for example, phenytoin and phenobarbitone. 6 A decrease in BMD (in g/cm 2 ) of 6.4% and 4.6% at the lumbar spine and femoral neck respectively in their twin control pair was detected. For valproate, the effect was not consistently demonstrated.…”

Hyperparathyroïdies secondaires (hors insuffisance rénale)

“…De plus, la phénytoïne et certains barbituriques inhiberaient directement l'absorption intestinale du calcium [35]. Cela explique pourquoi l'évaluation systématique de la réserve vitaminique D et sa correction sont fréquemment recommandées lors de tout traitement anticonvulsivant [36].…”