title: The effect of topiramate monotherapy on bone mineral density and markers of bone and mineral metabolism in premenopausal women with epilepsy.
abstract: OBJECTIVE
  To investigate the effect of topiramate on bone mass and metabolism in premenopausal women with epilepsy.
  
  
  METHODS
  Thirty-six women on long-term (at least 1 year) topiramate monotherapy were compared with 36 women taking carbamazepine, 32 women taking valproate, and 36 age- and sex-matched controls. Subjects completed bone mineral density (BMD) studies. Serum was analyzed for indices of bone metabolism.
  
  
  RESULTS
  BMD Z-scores, and serum 25-hydroxyvitamin D and 1alpha,25-dihydroxyvitamin D(3) concentrations did not differ among the groups. Serum calcium concentrations were significantly lower in patients receiving topiramate than in those receiving valproate, and in patients receiving carbamazepine than in those receiving valproate and controls. Patients taking topiramate had lower levels of parathyroid hormone compared with controls and those taking carbamazepine or valproate. Patients receiving topiramate had higher levels of bone-specific alkaline phosphatase and osteocalcin when compared with controls and higher levels of C-terminal telopeptide of type 1 collagen when compared with those taking carbamazepine or valproate. Patients receiving carbamazepine had higher levels of bone-specific alkaline phosphatase compared with controls and those receiving valproate. Serum bicarbonate concentrations were significantly lower in patients receiving topiramate than in the other groups.
  
  
  CONCLUSIONS
  Our results demonstrate that use of topiramate is associated with lower parathyroid hormone and bicarbonate concentrations along with mild hypocalcemia and increased bone turnover, which suggests that topiramate may have long-term effects on bone.
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seodaemungu, Seoul, Korea. kheo@yuhs.ac
authors.forename: Kyoung
authors.initials: K
authors.lastname: Heo
authors.forename: Yumie
authors.initials: Y
authors.lastname: Rhee
authors.forename: Hyang Woon
authors.initials: HW
authors.lastname: Lee
authors.forename: Sang Ahm
authors.initials: SA
authors.lastname: Lee
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Shin
authors.forename: Won-Joo
authors.initials: WJ
authors.lastname: Kim
authors.forename: Hong-Ki
authors.initials: HK
authors.lastname: Song
authors.forename: Kijun
authors.initials: K
authors.lastname: Song
authors.forename: Byung In
authors.initials: BI
authors.lastname: Lee
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001639:Bicarbonates / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D002113:Calcification, Physiologic / Q000187:drug effects*; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D000077236:Topiramate; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D000927:Anticonvulsants; D001639:Bicarbonates; D000077236:Topiramate; D014807:Vitamin D; D005632:Fructose; D002220:Carbamazepine; D014635:Valproic Acid; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002117:Calcitriol; D002118:Calcium