| Objective To investigate the effects of epilepsy and anti-epileptic drugs (AEDs) on bone mineral density (BMD) and bone metabolism of patients with epilepsy, and to direct the clinicists prevent and treat abnormal BMD and bone metabolism, then reduce the risk of fractures and improve the quality of life in epileptics.Materials and Methods All cases were selected from Tianjin Medical University General Hospital from March2012to March2013in this study and were stratified two groups according to the corresponding standard. Detailed clinical information of each patient were obtained by the researcher. Study one:160cases aged between20and60years old were selected as subjects. All of them had the disease for more than nine months and had been taking AEDs for more than six months. All were free of other diseases and none was taking any medication that might interfere with bone metabolism other than AEDs. BMDs at the right heel were measured with the ultrasonic BMD instrument. All of the related risk factors in the data were stratified according to certain degree and50the same age-range and sex-matched volunteers serving as controls. Then Single factor chi-square test and multivariate logistic regression analysis were analyzed. Study two included two parts, part one:60cases aged between20and50years old were selected. All of them had the disease for more than nine months and had been taking sodium valproate (VPA) or oxcarbazepine (OXC) monotherapy for more than six months.50patients who were not taking medicine as control group. Serum concentrations of calcium(Ca), phosphate(P), alkaline phosphatase(ALP) and parathyroid hormone(PTH) and BMD were examined in all patients and controls. Part two:Thirty patients with epilepsy and thirty normal controls were involved. Serum indicators like part one were measured in healthy controls and in treatment group before,3and6month after anti-epileptic drug (OXC) monotherapy treatment.Resultsâ‘ There was statistically significant difference between epileptics and normal group in BMD (P<0.01). Single factor chi-square test revealed that generalized tonic-clonic seizure (GTCS), polypharmacy and the duration of anticonvulsant therapy were significantly correlated with BMD (P<0.05). None of the course of epilepsy, hepatic enzyme-inducing and-noninducing AED was significantly associated with low BMD (P>0.05).Multivariate logistic regression analysis identified GTCS, polytherapy and the duration of anticonvulsant therapy were as the related and independent risk factors (OR value,1.105,5.710,5.820, respectively; P<0.05).â‘¡Serum concentrations of Ca, P, PTH were lower in VPA group than control group (P>0.05) and ALP levels were significant higher than control group (P<0.05); serum concentrations of Ca, P in patients on OXC were lower than control group (P>0.05) and PTH, ALP levels were pronounced higher than control groups (P<0.01).â‘¢There were no significant differences in bone metabolism between patients before therapy and normal group. Those indices, as Ca, P levels showed no marked changes after3month treatment in patients,the same as after6. PTH levels after3were higher than those before treatment (P>0.05) but significant higher after6(P<0.05). ALP levels both after3and6month treatment were higher than those before treatment (P>0.05).Conclusion The results indicate that both epilepsy and AEDs can lead to the change of BMD of patients with epilepsy, and GTCS, polytherapy and the duration of anticonvulsant therapy are important risk factors of low BMD. AEDs can influence bone metabolism and BMD in epileptics, secondary hyperparathymidism can be caused by OXC and VPA. It can be used as valuable reference to prevent bone mass loss and fractures of epileptic patients effectively. |
