The effects of antiepileptic drugs on bone health: A systematic review

•There is little compelling evidence supporting that enzyme-inducers are more harmful to bone than non-enzyme inducers.•Biochemical serum markers of bone turnover do not reliably correlate with changes in bone density.•Bone loss is less likely to be observed during initial years of antiepileptic dru...

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Published inEpilepsy research Vol. 173; p. 106619
Main Authors Griepp, Daniel W., Kim, David J., Ganz, Marc, Dolphin, Eugene J., Sotudeh, Nadia, Burekhovich, Steven A., Naziri, Qais
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.07.2021
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Abstract •There is little compelling evidence supporting that enzyme-inducers are more harmful to bone than non-enzyme inducers.•Biochemical serum markers of bone turnover do not reliably correlate with changes in bone density.•Bone loss is less likely to be observed during initial years of antiepileptic drug therapy Epilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting and variable, and little is known with regard to how duration of AED use or specific AEDs, such as CYP-450 enzyme-inducing (EIAEDs) versus non-enzyme inducing (NEIAEDs) drugs affect BMD. We sought to systematically review BMD changes due to AED use to identify trends in reporting. A literature search via Medline (PubMed), EMBASE, and Cochrane databases was performed. Peer-reviewed articles were identified that reported on BMD measurements in conjunction with AEDs. Twenty-six studies met inclusion criteria. Long-term therapy was shown across multiple, well-controlled studies to have the most significant BMD loss. Carbamazepine had the most frequent reporting of unfavorable effects on bone health and Lamotrigine seemed to show the most bone-protective qualities. Serum biochemical markers of bone turnover did not significantly correlate with measured BMD changes. The present study provides evidence that long-term AED therapy is the most significant risk factor for BMD loss. Furthermore, there was little compelling evidence to support that EIAEDs, as a class, were more harmful to bone than NEIAEDs, which has been previously suggested in multiple studies. Early clinical concern for significant loss of BMD may not be warranted as lower BMD was less likely to be observed during the initial years of AED therapy. Furthermore, serum markers of bone turnover are not clinically reliable in assessing BMD changes in patients taking AEDs.
AbstractList Epilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting and variable, and little is known with regard to how duration of AED use or specific AEDs, such as CYP-450 enzyme-inducing (EIAEDs) versus non-enzyme inducing (NEIAEDs) drugs affect BMD. We sought to systematically review BMD changes due to AED use to identify trends in reporting. A literature search via Medline (PubMed), EMBASE, and Cochrane databases was performed. Peer-reviewed articles were identified that reported on BMD measurements in conjunction with AEDs. Twenty-six studies met inclusion criteria. Long-term therapy was shown across multiple, well-controlled studies to have the most significant BMD loss. Carbamazepine had the most frequent reporting of unfavorable effects on bone health and Lamotrigine seemed to show the most bone-protective qualities. Serum biochemical markers of bone turnover did not significantly correlate with measured BMD changes. The present study provides evidence that long-term AED therapy is the most significant risk factor for BMD loss. Furthermore, there was little compelling evidence to support that EIAEDs, as a class, were more harmful to bone than NEIAEDs, which has been previously suggested in multiple studies. Early clinical concern for significant loss of BMD may not be warranted as lower BMD was less likely to be observed during the initial years of AED therapy. Furthermore, serum markers of bone turnover are not clinically reliable in assessing BMD changes in patients taking AEDs.
•There is little compelling evidence supporting that enzyme-inducers are more harmful to bone than non-enzyme inducers.•Biochemical serum markers of bone turnover do not reliably correlate with changes in bone density.•Bone loss is less likely to be observed during initial years of antiepileptic drug therapy Epilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting and variable, and little is known with regard to how duration of AED use or specific AEDs, such as CYP-450 enzyme-inducing (EIAEDs) versus non-enzyme inducing (NEIAEDs) drugs affect BMD. We sought to systematically review BMD changes due to AED use to identify trends in reporting. A literature search via Medline (PubMed), EMBASE, and Cochrane databases was performed. Peer-reviewed articles were identified that reported on BMD measurements in conjunction with AEDs. Twenty-six studies met inclusion criteria. Long-term therapy was shown across multiple, well-controlled studies to have the most significant BMD loss. Carbamazepine had the most frequent reporting of unfavorable effects on bone health and Lamotrigine seemed to show the most bone-protective qualities. Serum biochemical markers of bone turnover did not significantly correlate with measured BMD changes. The present study provides evidence that long-term AED therapy is the most significant risk factor for BMD loss. Furthermore, there was little compelling evidence to support that EIAEDs, as a class, were more harmful to bone than NEIAEDs, which has been previously suggested in multiple studies. Early clinical concern for significant loss of BMD may not be warranted as lower BMD was less likely to be observed during the initial years of AED therapy. Furthermore, serum markers of bone turnover are not clinically reliable in assessing BMD changes in patients taking AEDs.
PURPOSEEpilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting and variable, and little is known with regard to how duration of AED use or specific AEDs, such as CYP-450 enzyme-inducing (EIAEDs) versus non-enzyme inducing (NEIAEDs) drugs affect BMD. We sought to systematically review BMD changes due to AED use to identify trends in reporting. METHODSA literature search via Medline (PubMed), EMBASE, and Cochrane databases was performed. Peer-reviewed articles were identified that reported on BMD measurements in conjunction with AEDs. RESULTSTwenty-six studies met inclusion criteria. Long-term therapy was shown across multiple, well-controlled studies to have the most significant BMD loss. Carbamazepine had the most frequent reporting of unfavorable effects on bone health and Lamotrigine seemed to show the most bone-protective qualities. Serum biochemical markers of bone turnover did not significantly correlate with measured BMD changes. CONCLUSIONThe present study provides evidence that long-term AED therapy is the most significant risk factor for BMD loss. Furthermore, there was little compelling evidence to support that EIAEDs, as a class, were more harmful to bone than NEIAEDs, which has been previously suggested in multiple studies. Early clinical concern for significant loss of BMD may not be warranted as lower BMD was less likely to be observed during the initial years of AED therapy. Furthermore, serum markers of bone turnover are not clinically reliable in assessing BMD changes in patients taking AEDs.
ArticleNumber 106619
Author Dolphin, Eugene J.
Sotudeh, Nadia
Kim, David J.
Burekhovich, Steven A.
Naziri, Qais
Ganz, Marc
Griepp, Daniel W.
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Keywords NEIAEDs
VPA
Epilepsy
LS
FN
AEDs
TPM
CLZ
Osteoporosis
GBP
EIAEDs
BMD
CBZ
PHT
ESM
Osteopenia
MP
Antiepileptic
VGB
PB
DEXA
Long-term therapy
Bone mineral density
OXC
LEV
LTG
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Snippet •There is little compelling evidence supporting that enzyme-inducers are more harmful to bone than non-enzyme inducers.•Biochemical serum markers of bone...
Epilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting and...
PURPOSEEpilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting...
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StartPage 106619
SubjectTerms Anticonvulsants - adverse effects
Antiepileptic
Bone Density
Bone mineral density
Carbamazepine - adverse effects
Epilepsy
Epilepsy - drug therapy
Humans
Lamotrigine - pharmacology
Lamotrigine - therapeutic use
Long-term therapy
Osteopenia
Osteoporosis
Title The effects of antiepileptic drugs on bone health: A systematic review
URI https://dx.doi.org/10.1016/j.eplepsyres.2021.106619
https://www.ncbi.nlm.nih.gov/pubmed/33774428
https://search.proquest.com/docview/2506508916
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