Bone Density And Antiepileptic Drugs A Case-Controlled Study

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.

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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.

A recent study in 108 patients concluded that newer generation (lamotrigine, topiramate, and clonazepam) AEDs are associated with low BMD.

However, the patients were also on treatment with one of the conventional drugs leading to inability to arrive at conclusive evidence.

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.On the contrary, the data from a retrospective cohort study following 560 patients reported that patients prescribed newer, nonenzyme-inducing anticonvulsants were less expected to have osteoporosis at the lumbar spine, femoral neck, and hip suggesting that newer anticonvulsant medications are not associated with lower BMD.Likewise, another study in 13 children on lamotrigine monotherapy compared to 36 control subjects and 40 patients exposed to polytherapy concluded that lamotrigine may not interfere with the bone growth.Many biochemical abnormalities have been shown be associated with the use of AEDs such as hypocalcemia, hypophosphatemia, reduced serum levels of Vitamin D (biologically active metabolites), and increase in parathormone (PTH) levels.Alkaline phosphatase, osteocalcin, and C-terminal extension peptide of Type I procollagen which are the markers of bone turnover and cross-linked carboxyterminal telopeptide of human Type I collagen and hydroxyproline which are the markers of bone resorption are found to be elevated.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.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.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.

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