Adverse effects of antiepileptic drugs on bone mineral density in children

Area of Science:

• Pediatrics
• Neurology
• Endocrinology

Background:

• Epilepsy and its treatments can impact bone mineral content (BMC) and bone mineral density (BMD) in children.
• Understanding the effects of antiepileptic drugs (AEDs) on pediatric BMD is crucial for long-term health.
• Existing research highlights potential risks associated with certain AEDs.

Purpose of the Study:

• To systematically review the existing literature on the effects of antiepileptic drugs (AEDs) on bone mineral density (BMD) in children.
• To identify specific AEDs associated with decreased BMD in pediatric populations.
• To highlight gaps in current research regarding AEDs and pediatric BMD.

Main Methods:

• A systematic literature search was conducted using the Pubmed database.
• 14 relevant papers describing changes in BMD in children using AEDs were identified and analyzed.
• Data on specific AEDs including phenytoin, phenobarbital, carbamazepine, and valproate were extracted and synthesized.

Main Results:

• Phenytoin and phenobarbital showed potential decreases in BMD, particularly with use exceeding two years.
• Valproate demonstrated varied effects, with consistent decreases reported in forearm BMD.
• Carbamazepine did not show significant associations with decreased BMD in the reviewed studies.
• Vitamin D supplementation showed potential improvement in BMC in some children on AEDs.

Conclusions:

• Evidence suggests that certain AEDs, like phenytoin and phenobarbital, may negatively impact pediatric BMD, especially with prolonged use.
• Valproate appears to affect forearm BMD, necessitating further investigation.
• There is a significant lack of research on newer AEDs and their effects on pediatric BMD.
• Longitudinal studies and research into interventions are needed to address decreased BMD in children with epilepsy.