Long-term effects of carbamazepine on bone-related biochemical markers in patients with epilepsy

Carbamazepine (CBZ) is a commonly prescribed antiseizure medication frequently prescribed for epilepsy, trigeminal neuralgia, and mood disorders. However, CBZ is a strong inducer of cytochrome P450 enzymes, which can accelerate the catabolism of vitamin D and potentially alter bone metabolism. This study aimed to evaluate the effects of long-term CBZ administration on bone health in patients with epilepsy.

An observational study involving 226 patients was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. We analyzed the pre- and post-treatment serum levels of vitamin D (nmol/L), alkaline phosphatase (U/L), sodium (mmol/L), and calcium (mmol/L) to assess biochemical changes associated with prolonged CBZ therapy.

The analysis of vitamin D revealed a significant decrease after CBZ treatment (mean ± SD= 36.6 ± 15.68 nmol/L) compared to pre-treatment (45 ± 23.25 nmol/L) with a 95% CI of -14.47 to -2.37 and P = 0.007. Additionally, following the administration of CBZ, serum levels of calcium and sodium were both significantly reduced with P < 0.001 and P = 0.019, respectively. However, alkaline phosphatase levels showed no significant change.

The study outcomes suggest a potential association between long-term CBZ use and bone health, as supported by the presence of biochemical abnormalities. Furthermore, these findings underscore the importance of proactive clinical screening and bone-preserving interventions. Moreover, further studies are recommended to address the management of epilepsy patients with impaired bone health.