Anti-epileptic medication and bone health.
BACKGROUND
Epilepsy is a common chronic neurological disorder, usually requiring long-term treatment with anti-epileptic drugs (AED). Many studies have reported that AED therapy is associated with metabolic bone disease and is a major iatrogenic risk factor for fractures. There remains uncertainty about the type(s) of bone disease due to AED treatment, and the pathogenesis of AED-associated fractures.


BACKGROUND
Deficits in bone mineral density (BMD) are widely reported in AED-treated patient populations. However, much of the research conducted to date has been limited by factors such as small sample size, potentially biased subject selection, a lack of selection of appropriate control data, and failure to take account of important confounding influences. The pathogenesis of AED-associated fractures is likely to be multifactorial, due to factors including reduced BMD, impaired bone quality (due to osteoporosis and/or osteomalacia), increased propensity to fall, and fractures associated with seizures or loss of consciousness.


CONCLUSIONS
Patients receiving long-term AED should be monitored for indices of bone health, including BMD and vitamin D status. Lifestyle factors should be optimized, vitamin D status maintained, and fall prevention strategies introduced as appropriate. Good seizure control is important. The use of additional, specific osteoporosis therapy is not evidence-based in this setting, but would appear reasonable in patients with clinically significant decreases in BMD, applying current treatment guidelines for osteoporosis.


CONCLUSIONS
There is a pressing need for improved understanding of the pathogenesis of AED-associated bone disease, for better definition of the risk associated with specific AED regimens, and for the development of evidence-based preventive and treatment approaches in this common but neglected disorder.
Petty
S J
SJ
University of Melbourne Department of Medicine, Royal Melbourne Hospital, Victoria, 3050, Australia.
O'Brien
T J
TJ
Wark
J D
JD
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000139:chemically induced* / Q000188:drug therapy; D002648:Child; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010024:Osteoporosis / Q000139:chemically induced / Q000188:drug therapy; D012307:Risk Factors
D000927:Anticonvulsants