Effects Of Antiepileptic Drugs On Bone Mineral Density And Bone Metabolism In Adult Patients With Epilepsy:A Meta-analysis

Objective:Assess the effects of antiepileptic drugs on the bone mineral density and bone metabolism in adult patients with epilepsy.Methods:We searched PubMed,EMbase,CNKI,VIP and WanFang Data from inception to June2018 to collect studies about the effects of antiepileptic drugs on bone mineral density and bone metabolism in adult patients with epilepsy.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then,Meta-analysis was performed using RevMan 5.3 software.Results:24 studies were finally included.We identified:1.Bone mineral density:compared with the control group,bone mineral density of lumbar spine?SMD=-0.70,95%CI-1.06 to-0.34,P=0.000 1?,femoral neck?SMD=-0.48,95%CI-0.67 to-0.29,P<0.000 01?and total hip?SMD=-0.35,95%CI-0.53 to-0.18,P<0.000 1?were decreased.?1?Effect on bone mineral density of lumbar spine:valproic acid could decline the bone mineral density of lumbar spine?SMD=-0.39,95%CI-0.65 to-0.13,P=0.003?,and carbamazepine had no effect on that?SMD=-0.57,95%CI-1.60 to 0.47,P=0.29?].?2?Effect on bone mineral density of femoral neck:carbamazepine?SMD=-0.69,95%CI-1.14 to-0.23,P=0.000 2?and valproic acid?SMD=-0.30,95%CI-0.58 to-0.02,P=0.03?could decline the bone mineral density of femoral neck.?3?Effect on bone mineral density of total hip:carbamazepine could decline the bone mineral density of total hip?SMD=-0.47,95%CI-0.84 to-0.10,P=0.01?,and valproic acid had no effect on that?SMD=-0.19,95%CI-0.46 to-0.09,P=0.19?.2.Bone metabolism:compared with the control group,serum calcium?SMD=-0.64,95%CI-1.02 to 0.27,P=0.0007?and 25-hydroxy vitamin D3?SMD=-0.38,95%CI-0.65 to-0.10,P=0.007?were decreased,and serum parathormone?SMD=1.03,95%CI 0.47to 1.59,P=0.000 3?was increased.?1?Effect on serum calcium:serum calcium was decreased in carbamazepine?SMD=-0.49,95%CI-0.78 to-0.20,P=0.000 8?,levetiracetam?SMD=-0.83,95%CI-1.15 to-0.51,P<0.000 01?and oxcarbazepine?SMD=-0.48,95%CI-0.90 to-0.05,P=0.03?,but there was no statistical difference in valproic acid?SMD=0.09,95%CI-0.97 to 1.14,P=0.87?or topiramate?SMD=-1.40,95%CI-3.10 to 0.30,P=0.11?.?2?Effect on serum parathormone:serum parathormone was increased in carbamazepine?SMD=0.61,95%CI 0.05 to 1.16,P=0.03?,but there was no statistical difference in valproic acid?SMD=0.49,95%CI--0.24 to 1.22,P=0.19?or topiramate?SMD=2.07,95%CI-1.42 to 5.57,P=0.24?.?3?Effect on serum 25?OH?D₃:carbamazepine?SMD=-0.25,95%CI-0.72 to 0.22,P=0.30?,valproic acid?SMD=0.20,95%CI-0.44 to 0.85,P=0.53?and topiramate?SMD=-0.54,95%CI-1.59 to 0.51,P=0.31?had no effect on serum 25?OH?D₃.Conclusion:Antiepileptic drugs may decrease bone mineral density and affect bone metabolism in adult patients with epilepsy.Antiepileptic drugs have different effects on bone mineral density in different parts and bone metabolism.