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Bone disease in epilepsy.

Alison M Pack1

  • 1New York Neurological Institute, 710 West 168th Street, New York, NY 10032, USA. ap390@columbia.edu

Current Neurology and Neuroscience Reports
|June 26, 2004
PubMed
Summary
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Antiepileptic drugs (AEDs) are linked to bone disease, causing decreased bone mineral density (BMD) and biochemical changes. While vitamin D levels may not be the sole cause, effective treatments for this bone condition require further investigation.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Bone Metabolism

Background:

  • Emerging literature indicates a significant association between antiepileptic drug (AED) use and the development of bone disease.
  • Both enzyme-inducing and enzyme-inhibiting AEDs, including valproate, have been implicated in reduced bone mineral density (BMD) in pediatric and adult populations.

Purpose of the Study:

  • To review the current understanding of antiepileptic drug-associated bone disease.
  • To explore the biochemical abnormalities and potential mechanisms involved.
  • To assess the current therapeutic landscape for AED-induced bone disease.

Main Methods:

  • Literature review of studies investigating AEDs and bone health.
  • Analysis of biochemical markers related to bone metabolism (calcium, parathyroid hormone, bone formation/resorption markers).

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  • Examination of the role of vitamin D and other potential causative factors.

    • Main Results:

    • Decreased BMD is observed in patients using various AEDs.
    • Biochemical abnormalities include hypocalcemia, elevated parathyroid hormone, and altered bone turnover markers.
    • Low BMD appears independent of vitamin D status in recent studies, suggesting multifactorial etiology.
    • No single mechanism fully explains AED-associated bone disease.

    Conclusions:

    • AEDs pose a risk for significant bone disease, characterized by reduced BMD and metabolic disturbances.
    • The pathogenesis is complex and not solely attributable to vitamin D deficiency.
    • While treatments for bone disease exist, their efficacy in the context of AED use remains under-evaluated.