Relationship between bone density and levetiracetam monotherapy in epilepsy patients

Levetiracetam (LEV) is an anti-seizure drug (ASD). A consensus has not been reached regarding its effects on bone health. This cross sectional study was planned to assess short, medium and long-term effects on bone density and blood parameters that are associated with bone metabolism.

The sample consisted of 47 patients with epilepsy, who had been on LEV monotherapy for more than six months. All participants were over 18 years of age and had no other risk factors for osteoporosis. None of them used any other anti-seizure drug before. Bone mineral density (BMD) was evaluated with dual energy X-ray absorptiometry (DEXA) and biochemical markers associated with bone health were measured. Patients were divided into three groups depending on how long they had been on LEV for (Group A: <1 year; Group B: 1-5 years, Group C: >5 years) and compared with each other in terms of BMD scores and blood parameters.

The mean age of patients was 32. 6 ± 13.3 and 20 patients were female (42.5%). The mean onset age of epilepsy was 28.1 ± 13.4 years. Average LEV period of consumption was 2.7 ± 2.7 years and mean daily dose was 1041.7 ± 393.9 milligrams. Lumbar BMD scores of the group with LEV usage < 1 year were significantly lower than those of the group with LEV usage of 1-5 years (p < 0.05). Lumbar vertebra scores were found to be lower in group of LEV usage duration of < 1 year when compared with LEV usage duration > 5 years but the difference was not statistically significant.

We argue that LEV might have a negative effect on bone densitometry at the lumbar level in short-time usage for less than one year. Furthermore, no deleterious impact on bone metabolism was observed in long-term treatment. LEV seems as a rational drug for treatment of epilepsy patients, particularly for those with osteoporosis, since the comparative results of one year and longer than 5-years usage data did not show any statistically significant difference.