抗发作药物和骨健康
Paula V Gaete1, Valentina Cuellar-Rodríguez2, Carlos O Mendivil3,4
1Department of Neurology, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
Neurology and therapy
|September 1, 2025
概括
抗发作药物 (ASM) 通过影响维生素D和骨细胞功能,会对骨健康产生负面影响. 对于患者来说,优先考虑具有较低骨影响的ASM和评估骨折风险至关重要.
科学领域:
- 骨生物学和药理学
- 的治疗和患者的结果
背景情况:
- 治疗往往需要使用抗发作药物 (ASM),从而增加预期寿命,导致长时间的暴露.
- 人们越来越关注ASM对老年患者骨健康的不良影响.
研究的目的:
- 审查和综合各种抗发作药物对骨生物学影响的现有知识.
- 识别可能对骨健康造成较低风险的ASM,并为临床实践提供信息.
主要方法:
- 对抗药物及其对骨代谢的影响现有研究的文献综述.
- 分析不同类型的ASM对维生素D,甲状腺激素 (PTH) 和骨细胞 (骨质细胞和骨质细胞) 的影响机制.
主要成果:
- 诱导细胞染色体P450的ASM降低了活性维生素D,提高了PTH,并增加了骨质再吸收.
- 瓦尔酸会影响维生素D,激活骨质细胞,并损害骨质细胞.
- 托皮拉胺与骨矿物质密度降低和PTH增加有关; 莱维他赛特具有良好的骨质特征; 拉科萨米德和拉莫特林比其他通道阻断剂更好.
结论:
- ASM通过各种机制显著影响骨生物学,包括维生素D和PTH调节以及直接影响骨细胞.
- 在临床上可行的情况下,建议优先考虑对骨健康影响较小的ASM,如 levetiracetam,lacosamide和lamotrigine.
- 对所有患有高风险ASM的患者进行骨折风险评估至关重要.
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