Bone health and antiseizure drugs: diagnosis and management

Authors: Noe, Katherine H; Schrader, Sara LP

Source: Aging Health, Volume 4, Number 1, February 2008 , pp. 75-84(10)

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Abstract:

There is growing evidence for the association of antiepileptic medications (AEDs) and bone disease. Increased rates of vitamin D deficiency, elevated laboratory markers of bone turnover and increased rates of osteopenia, osteomalacia and fracture have all been reported. Although most commonly attributed to anticonvulsants that induce hepatic cytochrome P450 (CYP) enzymes, recent studies suggest that valproate, a CYP inhibitor, is also problematic. Data specific to other newer AEDs are lacking. Drug-induced inactivation of vitamin D is the most widely proposed mechanism for AED-related bone disease, however, other not yet fully elucidated pathways must also contribute. There are currently no evidence-based guidelines for diagnosis or treatment of bone disease specific to persons on AED therapy. Periodic screening for vitamin D deficiency and with dual-energy x-ray absorptiometry is likely beneficial. Prophylactic supplementation with vitamin D and calcium can be considered for all patients on AEDs, unless it is clear that dietary intake is sufficient. Higher dose vitamin D therapy may be required in the presence of osteomalacia. For diagnosed osteoporosis, standard pharmacologic therapies including bisphosphonates can be utilized, but have yet to be formally studied in this population.

Keywords: antiepileptic drugs; bone mineral density; dual-energy x-ray absorptiometry; fractures; osteomalacia; osteoporosis; vitamin D

Document Type: Research article

DOI: http://dx.doi.org/10.2217/1745509X.4.1.75

Affiliations: 1: 1Mayo Clinic Arizona, Department of Neurology, 5777 East Mayo Boulevard Phoenix, AZ 85054, USA., Email: noe.katherine@mayo.edu

Publication date: 2008-02-01

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Bone health and antiseizure drugs: diagnosis and management

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