title: Effects of antiepileptic drugs on bone health and growth potential in children with epilepsy.
abstract: BACKGROUND
  Bone health may be impaired in children with epilepsy.
  
  
  OBJECTIVE
  Our objective was to characterize bone mineral density (BMD) and bone growth in children receiving antiepileptic drugs (AEDs) and to assess the effects of co-morbidity, vitamin D deficiency, and type of drugs used.
  
  
  METHODS
  Data were sourced from PubMed, Embase, and Web of Science.
  
  
  METHODS
  Cross-sectional, cohort, case-control, or randomized controlled trials reporting BMD or parameters of bone growth.
  
  
  METHODS
  Children with epilepsy compared with controls.
  
  
  METHODS
  AEDS or ketogenic diet.
  
  
  METHODS
  The studies were evaluated by one author.
  
  
  METHODS
  Studies were categorized as reporting reduced BMD or not at any skeletal site as outcome. A logistic regression was performed for age, percent boys, study design, type of AED, co-morbidity or not, and signs of vitamin D deficiency/osteomalacia or not.
  
  
  RESULTS
  Carbamazepine and valproate were analyzed as monotherapy in 11 studies, and for both drugs a limited decrease in BMD seemed present. For oxcarbazepine, levetiracetam, phenytoin, phenobarbital, and topiramate, only one study with monotherapy was found for each drug, none of which reported decreased bone density. Polytherapy with AEDs seemed to be associated with a larger decrease in bone density than was monotherapy. Although few studies were available on bone growth, these did indicate that bone growth may be impaired among users of AEDs. Ketogenic diet may be associated with decreased bone density. The main determinant of normal BMD was absence of vitamin D deficiency/osteomalacia.
  
  
  CONCLUSIONS
  The studies differed in skeletal sites studied and most were cross-sectional. No head-to-head comparisons of AEDs were performed. Children treated with polytherapy or ketogenic diet may have more complicated and severe disease than those treated with monotherapy. The underlying cause of epilepsy and vitamin D deficiency may contribute to impaired bone growth and density.
  
  
  CONCLUSIONS
  Reduced bone density, impaired bone growth, and vitamin D deficiency may be seen in children treated with drugs against epilepsy.
  
  
  CONCLUSIONS
  Measures to correct vitamin D deficiency, calcium intake should be taken.
authors.affiliation: Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark, p-vest@post4.tele.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects; D002648:Child; D015897:Comorbidity; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000927:Anticonvulsants