Bone density and bone turnover markers in patients with epilepsy on chronic antiepileptic drug therapy.
In this comparative, cross-sectional study, we evaluated 55 patients with epilepsy on chronic use of antiepileptic drugs (AED); [(38 females and 17 males, 35 +/- 6 years (25 to 47)] and compared to 24 healthy subjects (17 females/7 males). Laboratorial evaluation of bone and mineral metabolism including measurements of bone specific alkaline phosphatase (BALP) and carboxyterminal telopeptide of type I collagen (CTX-I) were performed. Bone mineral density (BMD) was measured by DXA. BALP and CTX-I levels did not differ significantly between the groups. CTX-I levels were significantly higher in patients who were exposed to phenobarbital (P< 0.01) than those who were not. Patients presented BMD of both sites significantly lower than the controls (0.975 +/- 0.13 vs. 1.058 +/- 0.1 g/cm(2); p= 0.03; 0.930 +/- 0.1 vs. 0.988 +/- 0.12 g/cm(2); p= 0.02, respectively). Total hip BMD (0.890 +/- 0.10 vs. 0.970 +/- 0.08 g/cm(2); p< 0.003) and femoral neck (0.830 +/- 0.09 vs. 0.890 +/- 0.09 g/cm(2); p< 0.03) were significantly lower in patients who had been exposed to phenobarbital, in comparison to the non-phenobarbital users. In conclusion, patients on AED demonstrate reduced BMD. Among the AED, phenobarbital seems to be the main mediator of low BMD and increases in CTX-I.
Kulak
Carolina A M
CA
Serviço de Endocrinologia e Metabologia, Hospital de Clínicas, UFPR, Curitiba, PR, Brasil. kulakjc@uol.com.br
Borba
Victória Z C
VZ
Silvado
Carlos Eduardo
CE
Paola
Luciano de
Ld
Seibel
Markus J
MJ
Bilezikian
John P
JP
Boguszewski
César L
CL
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000927:Anticonvulsants / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood*; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000097:blood; D016723:Bone Remodeling / Q000187:drug effects*; D001842:Bone and Bones / Q000378:metabolism; D024042:Collagen Type I / Q000097:blood; D004164:Diphosphonates / Q000097:blood; D004812:Epidemiologic Methods; D004827:Epilepsy / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000627:therapeutic use*; D014807:Vitamin D / Q000378:metabolism
D000927:Anticonvulsants; D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D014807:Vitamin D; D000469:Alkaline Phosphatase; D010634:Phenobarbital