Antiseizure Medications and Bone Health

Area of Science:

• Bone Biology and Pharmacology
• Epilepsy Treatment and Patient Outcomes

Background:

• Epilepsy management often involves antiseizure medications (ASM), with increasing life expectancy leading to prolonged exposure.
• Growing concern exists regarding the adverse effects of ASM on bone health in the aging epilepsy population.

Purpose of the Study:

• To review and synthesize current knowledge on the impact of various antiseizure medications on bone biology.
• To identify ASM with potentially lower risks to bone health and inform clinical practice.

Main Methods:

• Literature review of existing studies on antiseizure medications and their effects on bone metabolism.
• Analysis of mechanisms by which different ASM classes influence vitamin D, parathyroid hormone (PTH), and bone cells (osteoblasts and osteoclasts).

Main Results:

• Cytochrome P450 inducing ASM reduce active vitamin D, elevate PTH, and increase bone resorption.
• Valproic acid impacts vitamin D, activates osteoclasts, and impairs osteoblasts.
• Topiramate is linked to reduced bone mineral density and increased PTH; levetiracetam shows a favorable bone profile; lacosamide and lamotrigine are preferable to other sodium channel blockers.

Conclusions:

• ASM significantly impact bone biology through various mechanisms, including vitamin D and PTH regulation and direct effects on bone cells.
• Prioritizing ASM with a lower impact on bone health, such as levetiracetam, lacosamide, and lamotrigine, is recommended when clinically feasible.
• Fracture risk assessment is essential for all epilepsy patients on high-risk ASM.