Childhood and adolescence are critical periods of skeletal bone mineralization.
It has been found that peak bone mineral density (BMD) achieved by the end of adolescence will determine the risk for pathological fractures and osteoporosis in the later life.
Epilepsy is itself known to increase bone loss and the risk of fractures by a variety of mechanisms such as restrictions of physical activity imposed by seizures, coexisting neurological deficits, and seizure-related falls Bone biopsies and dual energy X-ray absorptiometry (DEXA) which are the gold-standard technique has provided both histological as well as radiographic evidence of bone abnormalities.
Bone loss associated with the use of AED is usually insidious and asymptomatic to start with and goes unrecognized for a long period and often untreated.
A recent study in 108 patients concluded that newer generation (lamotrigine, topiramate, and clonazepam) AEDs are associated with low BMD.
Bone Density And Antiepileptic Drugs A Case-Controlled Study
However, the patients were also on treatment with one of the conventional drugs leading to inability to arrive at conclusive evidence.Serum total and bone alkaline phosphatase were also significantly increased in ambulatory children with adequate sun exposure within 90 days of initiation of treatment with carbamazepine or valproic acid.A cross-sectional study on 71 patients showed lower BMD in subjects, on enzyme-inducing drugs such as phenytoin, phenobarbital, carbamazepine, and primidone than those on noninducers such as valproic acid, lamotrigine, clonazepam, gabapentin, topamirate, and ethosuximide.Over the past decade, there has been a proliferation of new AEDs which have been approved, promising a better quality of life with lesser adverse effects for many with epilepsy.However, the question now arises whether the newer AEDs, such as lamotrigine, gabapentin, vigabatrin, levetiracetam, and topiramate cause little or no adverse bone changes.Impact of antiepileptic drugs on bone health: Need for monitoring, treatment, and prevention strategies.J Family Med Prim Care [serial online] 2016 [cited 2019 Sep 6];8-53. 2016/5/2/248/192338 Medical treatment with antiepileptic drugs (AEDs) is the main-stay of treatment.Literature search reveals that the data on bone-specific effects of newer AEDs is limited with conflicting results.Oxcarbazepine, gabapentin and for levetiracetam in preclinical studies are associated with alterations of bone metabolism.Antiepileptic drugs (AEDs) constitute the main-stay of treatment with a large number of AEDs available in the market.High incidence of adverse effects is a major limitation with AEDs.