Impact of Pharmaceutical Care on Bone Health in Epileptic Women Taking Antiepileptic Drugs: An Interventional Trial

Abstract

Antiepileptic drugs (AEDs) have adverse effects on bone mineral density (BMD) and an inverse relationship exists between bone health and the use of anti-epileptic drugs. The quality of bone is affected by the duration and the type of anti-epileptics used. Adults, particularly women are at more risk. The aim of the trial was to determine the impact of pharmaceutical care on bone mineral density of epileptic women taking AEDs for at least two years. Participants (n = 29) were randomly assigned to either control group or intervention group. The control group patients received usual physician care while the intervention group received interventions from a clinical pharmacist like educational intervention and pharmacotherapy intervention in the form of supplements. Primary outcome measures were femoral neck and lumbar spine BMD, which is expressed as T-score. BMD was determined by dual-energy X-ray absorptiometry (DEXA) in 30 epileptic women taking AEDs for more than two years. Outcomes were assessed at baseline and 12 months in both groups. The mean (±SD) changes in BMD in the intervention and control groups were: femoral neck +0.52±4.81 and-0.71±5.03 respectively (p<0.01) and spine +2.15±4.01 and +1.22±4.23 respectively (p<0.01). The difference between the interventional and control groups was significant at femoral neck and lumbar spine regions. We found that supplementation with calcium and vitamin D moderately reduced bone loss measured in femoral neck and lumbar spine regions over a one-year period through pharmacist-led intervention. Overall, the current study underscores the importance of pharmacist's intervention on bone health in epileptic women.