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Bone mass and turnover in women with epilepsy on antiepileptic drug monotherapy
Author(s) -
Pack Alison M.,
Morrell Martha J.,
Marcus Robert,
Holloway Leah,
Flaster Edith,
Doñe Silvia,
Randall Alison,
Seale Cairn,
Shane Elizabeth
Publication year - 2005
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.20378
Subject(s) - bone remodeling , lamotrigine , carbamazepine , phenytoin , endocrinology , medicine , osteocalcin , epilepsy , bone mineral , bone resorption , parathyroid hormone , alkaline phosphatase , pharmacology , calcium , osteoporosis , chemistry , biochemistry , psychiatry , enzyme
Antiepileptic drugs, particularly cytochrome P450 enzyme inducers, are associated with disorders of bone metabolism. We studied premenopausal women with epilepsy receiving antiepileptic drug monotherapy (phenytoin, carbamazepine, valproate, and lamotrigine). Subjects completed exercise and nutrition questionnaires and bone mineral density studies. Serum was analyzed for indices of bone metabolism including calcium, 25‐hydroxyvitamin D, parathyroid hormone, insulin growth factor I, insulin binding protein III, and bone formation markers, bone‐specific alkaline phosphatase, and osteocalcin. Urine was analyzed for cross‐linked N‐telopeptide of type I collagen, a bone resorption marker. Calcium concentrations were significantly less in subjects receiving carbamazepine, phenytoin, and valproate than in those receiving lamotrigine ( p = 0.008). Insulin growth factor‐I was significantly reduced in subjects receiving phenytoin compared with those receiving lamotrigine ( p = 0.017). Subjects receiving phenytoin had significantly greater levels of bone‐specific alkaline phosphatase ( p = 0.007). Our results demonstrate that phenytoin is associated with changes in bone metabolism and increased bone turnover. The lower calcium concentrations in subjects taking carbamazepine or valproate compared with those taking other antiepileptic drugs suggest that these antiepileptic drugs may have long‐term effects. Subjects receiving lamotrigine had no significant reductions in calcium or increases in markers of bone turnover, suggesting this agent is less likely to have long‐term adverse effects on bone. Ann Neurol 2005;57:252–257