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Published on: January 29, 2018
Determinants of low bone mineral density in children with epilepsy
Choong Yi Fong1, Ann Nie Kong1, Mazidah Noordin2
1Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Insights
Children with epilepsy on antiepileptic drugs (AEDs) face a high risk of low bone mineral density (BMD). Over 20% of Malaysian children studied had low BMD, with polytherapy and small frame size being key risk factors.
Area of Science:
- Pediatric Endocrinology
- Neurology
- Bone Metabolism
Background:
- Children with epilepsy on long-term antiepileptic drugs (AEDs) are susceptible to reduced bone mineral density (BMD).
- Understanding the prevalence and contributing factors of low BMD in this population is crucial for early intervention.
Purpose of the Study:
- To determine the prevalence of low bone mineral density (BMD) in Malaysian children with epilepsy.
- To identify significant risk factors associated with low BMD in this cohort.
Main Methods:
- A cross-sectional study involving 87 Malaysian children with epilepsy on AEDs for over one year.
- Evaluated anthropometric measurements, lifestyle factors, serum vitamin D, calcium, parathyroid hormone, and lumbar spine BMD (defined as Z-score ≤ -2.0 SD).
- Genotyping of genes involved in vitamin D and calcium metabolism was performed.
Main Results:
- The prevalence of low lumbar BMD was 21.8% (19 out of 87 children).
- Significant risk factors for low BMD included polytherapy (more than 2 AEDs), small frame size (wrist breadth <15th centile), and low body mass index Z-score (< -2.0).
- Polytherapy showed an odds ratio of 7.86 for low BMD.
Conclusions:
- Approximately one-fifth of Malaysian children with epilepsy on long-term AEDs exhibit low BMD.
- Children on more than two AEDs, those underweight, or with small frame size require targeted BMD screening.
- Early identification and intervention for these risk factors can help mitigate bone density loss.
Introduction:
Children with epilepsy on long-term antiepileptic drugs (AEDs) are at risk of low bone mineral density (BMD). The aims of our study were to evaluate the prevalence and determinants of low BMD among Malaysian children with epilepsy.
Method:
Cross-sectional study of ambulant children with epilepsy on long-term AEDs for >1 year seen in a tertiary hospital in Malaysia from 2014 to 2015. Detailed assessment of anthropometric measurements; environmental lifestyle risk factors; serum vitamin D, calcium and parathyroid hormone levels; genotyping of single nucleotide polymorphisms of genes in vitamin D and calcium metabolism; and lumbar spine BMD were obtained. Low BMD was defined as BMD Z-score ≤ -2.0 SD.
Results:
Eighty-seven children with mean age of 11.9 years (56 males) participated in the study. The prevalence of low lumbar BMD was 21.8% (19 patients). Multivariate logistic regression analysis identified polytherapy >2 AEDs (OR: 7.86; 95% CI 1.03-59.96), small frame size with wrist breadth of <15th centile (OR 14.73; 95% CI 2.21-98.40), and body mass index Z-score < -2.0 (OR 8.73, 95% CI 1.17-65.19) as significant risk factors for low BMD.
Conclusion:
One-fifth of Malaysian children with epilepsy on long-term AEDs had low BMD. Targeted BMD should be performed for those who are on >2 AEDs, underweight or with small frame size as they are at higher risk of having low BMD.
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