Fracture incidence and bone disease in epileptics receiving long-term anticonvulsant drug treatment

Nilsson, Olle; Elmstedt, Erik; Lindbäck, A.; Ts, Lindholm

doi:10.1007/bf00433931

Cited by 74 publications

(41 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other studies, especially in institutionalized patients, have demonstrated increased fracture rates in patients with epilepsy 17,18,19 . In our study, 25.8% of the patients reported seizure-related fractures, which was not surprisingly as many of our patients had uncontrolled seizures and required multiple drugs regime with high doses of AEDs, which are risk factors for falls and fractures.…”

Section: Discussionmentioning

confidence: 94%

“…Since seizure disorders are chronic and persist throughout life, it is very important to investigate and prevent metabolic bone disturbances in these individuals, particularly since many have other risk factors for osteoporosis such as lack of physical activity and reduced exposure to sunlight 3 . Moreover, increased fractures rates have been described in patients with epilepsy 17,18,19 .…”

Section: Palavras-chave: Drogas Antiepiléticas Indutoras Hepáticas 2mentioning

confidence: 99%

See 1 more Smart Citation

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Kulak

Borba

Bilezikian

et al. 2004

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

-The aim of this cross sectional study was to evaluate bone mineral density (BMD) and serum levels of 25-hydroxy vitamin D (25OHD) in a group of patients taking antiepileptic drugs (AED) for a seizure disorder. Between May-2001 and January-2003, we evaluated 58 patients (40 women/18 men), 34.4+6 years old living in Curitiba or in its metropolitan area, on antiepileptic therapy for 2 to 38 years (10 on monotherapy /48 on multiple drugs regime). The group was matched by age, gender, and bone mass index to 29 healthy subjects (20 women/ 9 men); 34.2+5.9 years old. Medical history and physical exam were performed on all subjects with particular information sought about fractures and risks factors for osteoporosis. Blood samples were collected for total serum calcium, albumin, phosphorus, creatinine, total alkaline phosphatase, and liver function tests. BMD of the lumbar spine, femur and forearm was determined by dual energy X-ray absorptiometry (DXA, Hologic QDR 1000). Between February and April-2003, other blood samples were collected to measure 25OHD, intact paratohormone (PTH) and calcium. Unemployment and smoking history were more frequent among patients than among controls (p<0.05). Fifteen patients had a fracture history, all of which occurred during a seizure. The BMD of the lumbar spine (0.975+0. 13 g/cm 2 vs. 1.058+0.1 g/cm 2 ; p<0.03) and of the total femur (0.930+0.1 g/cm 2 vs. 0.988+0.12 g/cm 2 ; p<0.02) was lower in patients than in controls. In 63.5% of patients and in 24.1 % of controls a T-score < -1.0 in at least one site was seen. The AED users had higher total alkaline phosphatase and lower 25OHD (p<0.02). No correlations between BMD and 25OHD were found. The use of phenytoin was correlated with a greater incidence of fractures (RR: 2.38). We conclude that patients on chronic use of AED have alterations in bone metabolism characterized in this study by lower BMD of the lumbar spine and total femur and lower serum concentrations of 25OHD.KEY WORDS: Enzyme-inducing antiepileptic drugs, 25OH vitamin D, osteomalacia. Densidade mineral óssea e níveis séricos de 25 OH vitamina D em usuários crônicos de drogas antiepilépticasRESUMO -O objetivo deste estudo transversal foi avaliar a densidade mineral óssea (DMO) e os níveis de 25hidroxi vitamina D (25OHD) em um grupo de pacientes com epilepsia e usuários crônicos de drogas antiepilépticas (DAE). Entre maio-2001 e janeiro-2003 avaliamos 58 pacientes (40 mulheres/18 homens) residentes em Curitiba ou região metropolitana da cidade, com média de idade 34,4+6 anos e tempo de tratamento entre 2 e 38 anos (10 em monoterapia/48 em politerapia). O grupo de pacientes foi emparelhado por idade, sexo e índice de massa corpórea com 29 indivíduos aparentemente sadios (20 mulheres/9 homens; 34,2+5,9 anos). Pacientes e controles foram submetidos a anamnese e exame clínico, com ênfase na história de fraturas e fatores de risco para osteoporose. Nas visitas foram coletadas amostras de sangue para dosagens de cálcio, albumina, fósforo, creatinina, fosfatase alcalin...

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Palavras-chave: Drogas Antiepiléticas Indutoras Hepáticas 2mentioning

confidence: 99%

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Kulak

Borba

Bilezikian

et al. 2004

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…Antiepileptic medications may affect intestinal calcium absorption and can induce anticonvulsant osteopathy. 8 Antiepileptic drugs have also been linked to a decrease in vitamin D, osteomalacia, and direct deleterious effects on bone-mineral metabolism independent of their effects on vitamin D. [7][8][9] These multiple effects may increase the susceptibility of long-term seizure patients to fracture. 2 The case presented here demonstrates the importance of evaluation for secondary injury in seizure patients.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Acetabular Fractures Associated With a Seizure: A Case Report

Friedberg

Buras

2005

Annals of Emergency Medicine

View full text Add to dashboard Cite

“…Also, another study from Nettekoven et al indicated that epilepsy is related with increased bone turnover although physical activity levels were not assessed during their study [29]. Bone biopsy studies in epileptic patients who sustained a fracture have found reduced bone formation and resorption, an increase in the size of haversian canals and an increased resorption of trabecular bone, a degree of osteoporosis, and also increased deposition of osteoid which is suggestive of osteomalacia [17,30].…”

Section: Aeds and Bone Cells And Bone Turnovermentioning

confidence: 99%

Metabolic bone disorders in children with epilepsy

Manolis¹,

Lepetsos²,

Tzefronis³

et al. 2017

Rheumatol Orthop Med

View full text Add to dashboard Cite

Epilepsy during childhood is the most usual neurological disease and it is characterized by recurrent seizures influencing the everyday life of children. As a treatment, antiepileptic drugs (AEDs) affect the bone metabolism resulting in osteoporosis, osteomalacia, rickets, abnormal dentition and increased rate of fractures. Reduced bone mass density (BMD) has been found in the majority of children with epilepsy and a large proportion of these patients has osteoporosis. Furthermore, in many studies the BMD in the epileptic children is significantly lower than in the healthy one. Overall nutritional status affects the manifestation of seizures and the physiology of bone tissue. Especially the levels of vitamin D and calcium play a vital role in the expression of epilepsy related bone disease (ERBD) in children.In parallel, epileptic children should be adequately mobilized as less physical daily activity and inability to walk independently lead to decreased BMD levels which are the major cause of increased number of fractures. Close monitoring of BMD, nutritional status evaluation and prevention of ERBD is as crucial as treatment of epilepsy with antiepileptic drugs, in order to prevent the expression of fractures. Every specialty involved in the treatment of epileptic children must be aware of the consequences of epilepsy in bone tissue.

show abstract

Fracture incidence and bone disease in epileptics receiving long-term anticonvulsant drug treatment

Cited by 74 publications

References 11 publications

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

Bilateral Acetabular Fractures Associated With a Seizure: A Case Report

Metabolic bone disorders in children with epilepsy

Contact Info

Product

Resources

About