title: Homocysteine and bone loss in epilepsy.
abstract: Epidemiological studies reveal fracture incidence in epilepsy is twice that of the normal population. Much interest has been focused on Vitamin D, however, considering mixed results on non-enzyme inducing anti-epileptic drugs (AEDs) and bone mineral density (BMD) additional metabolic effects may be to blame. AEDs increase serum homocysteine (s-Hcy) by lowering blood folate levels. An association between elevated homocysteine, BMD and increased fracture incidence has been found in non-epilepsy populations. Additionally, folate and Vitamin B12 levels are independently related to bone mineral density in various non-epilepsy populations. This study supports previous research, which found elevated s-Hcy in subjects taking AEDs and that bone loss is related to the use of enzyme-inducing AEDs and changes in alkaline phosphatase. By one-way ANOVA, subjects on phenytoin monotherapy had significantly higher levels of s-Hcy than those on other AEDs (F=5.89, p=.016). Regression analyses revealed homocysteine, fracture history, length of years on AEDs, ethnicity were predictors of spine T scores. Weight and BMI were predictors of both BMD and DEXA T scores. Use of enzyme-inducing AEDs was a negative predictor of spine BMD and T scores, while phenytoin monotherapy was a positive predictor of spine BMD. Lamotrigine was found to be a negative predictor of spine T score. Ambulatory status, menopause and alcohol consumption were predictors of BMD but not T scores. In this study, persons with epilepsy who take nutritional supplementation have 25% lower s-Hcy levels than those who do not. Supplementation continues to be important in preventative epilepsy care.
authors.affiliation: The Ohio State University, 2050 Kenny Road, Columbus, OH 43221, USA. John.Elliott@osumc.edu
authors.forename: John O
authors.initials: JO
authors.lastname: Elliott
authors.forename: Mercedes P
authors.initials: MP
authors.lastname: Jacobson
authors.forename: Zulfi
authors.initials: Z
authors.lastname: Haneef
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000009:adverse effects* / Q000494:pharmacology; D001806:Blood Urea Nitrogen; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000209:etiology; D002118:Calcium / Q000008:administration & dosage / Q000494:pharmacology; D004827:Epilepsy / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D005492:Folic Acid / Q000097:blood; D006615:Hip / Q000000981:diagnostic imaging; D006710:Homocysteine / Q000097:blood / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D012044:Regression Analysis; D013131:Spine / Q000000981:diagnostic imaging
chemical_list: D000927:Anticonvulsants; D006710:Homocysteine; D005492:Folic Acid; D002118:Calcium