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Effect of carbamazepine and valproate on bone mineral density
Ciğdem Ecevit1, Aysel Aydoğan, Tülay Kavakli
1Department of Pediatrics, Dr. Behçet Uz Children's Hopsital, 1374 Sokak no. 11, Alsancak, Izmir, Turkey.
Insights
Valproate monotherapy significantly reduces bone mineral density in children with epilepsy, unlike carbamazepine. This study highlights potential risks associated with valproate treatment in pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Neurology
- Pharmacology
Background:
- Epilepsy is a common neurological disorder in children.
- Antiepileptic drugs like carbamazepine and valproate are frequently used for monotherapy.
- Potential long-term effects of these medications on bone health require investigation.
Purpose of the Study:
- To evaluate the impact of carbamazepine and valproate monotherapy on bone mineral density (BMD) in children.
- To compare BMD changes between children with idiopathic epilepsy on monotherapy and healthy controls.
Main Methods:
- Dual-energy x-ray absorptiometry (DXA) was used to measure femoral neck bone mineral density.
- Study included 33 children with idiopathic epilepsy (17 on carbamazepine, 16 on valproate) and 31 healthy controls.
- Patients were treated for over 6 months; demographic and dietary factors were controlled.
Main Results:
- Valproate monotherapy was associated with a 31.9% reduction in femoral neck bone mineral density (P < 0.05).
- Carbamazepine monotherapy showed a non-significant 20% reduction in bone mineral density at the same site.
- Valproate group exhibited higher rates of hypocalcemia (25%) and hypophosphatemia (50%) compared to carbamazepine group.
Conclusions:
- Valproate monotherapy significantly decreases femoral neck bone mineral density in children with idiopathic epilepsy.
- Carbamazepine monotherapy did not show a significant effect on bone mineral density in this pediatric cohort.
- Findings suggest a potential risk of reduced bone mineral density with valproate use in children, warranting further monitoring.
Abstract:
The objective of this study was to examine the effect of carbamazepine and valproate monotherapy on bone mineral density in children. Femoral neck area bone mineral density was measured by dual-energy x-ray absorptiometry in 31 healthy children and 33 children with idiopathic epilepsy treated with either carbamazepine (n = 17) or valproate (n = 16) for more than 6 months. There were no significant differences between the control and study patients in age, height, weight, and physical activity. No patient had dietary restrictions or neurologic impairment. Serum levels (as mean +/- S.D.) of valproate and carbamazepine were 53.75 +/- 23.94 microg/mL and 6.26 +/- 2.00 microg/mL, respectively, and the duration of treatment for each drug was 24.38 +/- 10.58 months and 31.76 +/- 16.33 months, respectively. Calcium intake in the diet was similar in both the control and study groups. In the valproate-treated group, 25% of the patients were hypocalcemic, 6% had elevated alkaline phosphatase levels, and 50% were hypophosphatemic. In the carbamazepine-treated group, 17.6% of the patients were hypocalcemic and 35.3% were hypophosphatemic. Children treated with valproate had 31.9% reduction in bone mineral density at the femoral neck area (P < 0.05); the 20% reduction in bone mineral density in this anatomic location in carbamazepine-treated children was not significant. In conclusion, valproate monotherapy, but not carbamazepine therapy, significantly reduces femoral neck area bone mineral density in children with idiopathic epilepsy.
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