Evaluation of bone turnover in epileptic children using oxcarbazepine
Ali Cansu1, Ediz Yesilkaya, Ayşe Serdaroğlu
1Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey.
Insights
Oxcarbazepine monotherapy in children showed decreased vitamin D and increased osteocalcin, impacting bone turnover. While generally mild in children with normal bone density, careful monitoring is advised for those with pre-existing osteopenia.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
- Bone Metabolism
Background:
- Oxcarbazepine is an antiepileptic drug used in pediatric patients.
- Bone health is crucial during childhood growth and development.
- Potential effects of antiepileptic drugs on bone metabolism require evaluation.
Purpose of the Study:
- To assess the impact of oxcarbazepine monotherapy on bone turnover markers in children.
- To evaluate changes in bone mineral density and related biochemical markers.
- To identify potential risks of drug-induced osteopenia.
Main Methods:
- Prospective study of 34 newly diagnosed pediatric patients.
- Measurement of serum biochemical markers of bone formation and turnover.
- Assessment of 25-hydroxyvitamin D, gamma-glutamyl transferase, phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, and calcitonin.
- Bone mineral density (BMD) and Z-scores were evaluated before and after 18 months of treatment.
Main Results:
- Significant decrease in 25-hydroxyvitamin D levels post-treatment.
- Significant increases in osteocalcin and gamma-glutamyl transferase levels.
- Bone mineral density Z-scores decreased in 3 patients, indicating drug-induced osteopenia.
- Overall adverse effects on bone metabolism were considered mild in children with normal baseline BMD.
Conclusions:
- Oxcarbazepine monotherapy can lead to alterations in pediatric bone metabolism, including decreased vitamin D and increased osteocalcin.
- While effects appear minimal in children with normal bone density, careful monitoring is recommended for patients with pre-existing osteopenia, particularly during long-term treatment.
Abstract:
This study evaluated the effects of oxcarbazepine monotherapy on bone turnover in prepubertal and pubertal children. Thirty-four newly diagnosed pediatric patients with normal bone mineral density, serum biochemical markers of bone formation, and hormonal markers participated. Levels of 25-hydroxyvitamin D were significantly decreased after therapy compared with baseline values. Levels of gamma-glutamyl transferase, phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, and calcitonin had increased. However, only changes in osteocalcin and gamma-glutamyl transferase levels were statistically significant compared with baseline values. Drug-induced osteopenia was evident in 3 patients with z scores of bone-mineral density less than -2.0, whereas these patients had z scores of less than -1.5 before treatment. Although 18 months of oxcarbazepine treatment exerted slightly adverse effects on bone metabolism, the effect seems insignificant in children with normal bone-mineral density. Although alterations in bone metabolism do not always suffice to explain the decrease in bone-mineral metabolism, we think that patients with osteopenia before the initiation of oxcarbazepine therapy should be followed carefully, especially in long-term treatment.
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