title: Antiepileptic treatment is associated with bone loss: difference in drug type and region of interest.
abstract: The effects of antiepileptic drugs (AEDs) on bone mineral density (BMD) are well addressed, but data on children, especially concerning new antiepileptic medications, are scarce. This study aimed to reveal the impact of these drugs on the BMD of ambulatory patients with epilepsy.
  
  
  METHODS
  BMD and detailed clinical information were obtained on 108 patients and 38 controls using dual-energy x-ray absorptiometry. The patients were categorized into 2 groups: enzyme-inducing AEDs (EIAEDs) and non-EIAEDs. Also, the patients were classified as being in either a monotherapy or a polytherapy group. All patients completed a 63-item questionnaire. In this study, the raw value of BMD, T score, and z score of the spine, neck of femur, total hip, and forearm were analyzed.
  
  
  RESULTS
  Patients receiving AEDs showed diminished lumbar BMD, compared with controls (P < 0.05), regardless of the type of AED (EIAEDs or non-EIAEDs). In addition, there was a significant decrease in femoral neck BMD in patients receiving EIAEDs (0.922 ± 0.161, P < 0.05) but not in those treated with non-EIAEDs. Patients undergoing carbamazepine monotherapy (33 patients) showed diminished lumbar and femoral neck BMD, whereas those receiving valproate (22 patients) or undergoing polytherapy showed a BMD similar to that of controls in all studied regions of interest. There was no notable change in BMD in the Ward triangle, trochanter, or total hip in either the EIAED or the non-EIAED group.
  
  
  CONCLUSIONS
  AED therapy, especially in patients on new-generation medication, is associated with low bone density. It is hoped that the presented data stressing several clinical and diagnostic points will stimulate a high index of suspicion to facilitate early diagnosis and preventive care.
authors.affiliation: Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Hooman
authors.initials: H
authors.lastname: Salimipour
authors.forename: Sara
authors.initials: S
authors.lastname: Kazerooni
authors.forename: Mohammad
authors.initials: M
authors.lastname: Seyedabadi
authors.forename: Iraj
authors.initials: I
authors.lastname: Nabipour
authors.forename: Reza
authors.initials: R
authors.lastname: Nemati
authors.forename: Darioush
authors.initials: D
authors.lastname: Iranpour
authors.forename: Majid
authors.initials: M
authors.lastname: Assadi
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects; D001847:Bone Diseases / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: antiepileptic drugs (AEDs); bone mineral density (BMD); convulsion; dual-energy x-ray absorptiometry (DXA)