Antiepileptics and bone health

In recent years there has been increasing evidence suggesting that epilepsy and its treatment can have adverse effects on bone mineralization and calcium metabolism. Many studies have shown a significant reduction in bone mineral density (BMD) and an increased fracture risk in patients treated with...

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Bibliographic Details
Published in:Therapeutic Advances in Musculoskeletal Disease 2011-10, Vol.3 (5), p.235-243
Main Authors: Meier, Christian, Kraenzlin, Marius E.
Format: Article
Language:English
Subjects:
Bisphosphonates
Bone mineral density
Bone turnover
Calcium absorption
Calcium metabolism
Data processing
Drugs
Enzymes
Epilepsy
Etiracetam
Fractures
gabapentin
Metabolism
Metabolites
Mineralization
Phenobarbital
Phenytoin
Review
Risk assessment
Risk factors
Vitamin D
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Summary:In recent years there has been increasing evidence suggesting that epilepsy and its treatment can have adverse effects on bone mineralization and calcium metabolism. Many studies have shown a significant reduction in bone mineral density (BMD) and an increased fracture risk in patients treated with enzyme-inducing antiepileptics (phenobarbital, carbamazepine, phenytoin). It is assumed that CYP450-inducing antiepileptic drugs (AEDs) upregulate the enzymes which are responsible for vitamin D metabolism, with the effect of converting 25(OH) vitamin D into inactive metabolites, resulting in reduced calcium absorption with consecutive secondary hyperparathyroidism. Data on bone-specific effects of newer AEDs are limited; nevertheless, alterations of bone metabolism have been reported for oxcarbazepine, gabapentin and, in preclinical studies, for levetiracetam. Prophylactic administration of adequate amounts of calcium and vitamin D is recommended for all patients. For patients with long-term AED exposure, BMD measurement is recommended as part of osteoporosis investigation (especially for patients treated with enzyme-inducing AEDs and where there are major risk factors for fractures). Drug therapy (bisphosphonates) is reserved for the treatment of patients who have a high fracture risk; there are no specific intervention studies available in patients with epilepsy.
ISSN:1759-720X
1759-7218
DOI:10.1177/1759720X11410769