Gissel Tina, Poulsen Carsten Søndergaard, Vestergaard Peter
Aalborg Hospital, Department of Endocrinology, Hobrovej, Aalborg, Denmark.
Expert Opin Drug Saf. 2007 May;6(3):267-78. doi: 10.1517/14740338.6.3.267.
Bone mineral content (BMC) or density (BMD) may be decreased in children with epilepsy either as a consequence of the epilepsy, the condition that caused the epilepsy or the treatment for epilepsy. This paper investigates the effects of antiepileptic drugs (AEDs) on BMD in children. A systematic search of Pubmed resulted in 14 papers that described changes in BMD in children on AEDs. For phenytoin, one study failed to show a decrease in femur BMD, whereas another study reported a decrease in total body and spine BMD, but only with the use of phenytoin for > 2 years. With phenytoin combined with a ketogenic diet, a decrease in forearm BMC was seen. For phenobarbital, one study showed a decrease in spine and total body BMD, but only among those who had used phenobarbital for > 2 years. Six studies were available for carbamazepine, and none of these showed a decrease in BMD in any skeletal site. For valproate, results were diverse; two studies reported a decrease in spine BMD, whereas two other studies did not. Two studies reported a decrease in hip BMD with valproate, whereas one did not. All three studies on forearm BMD in users of valproate described a decrease. Three studies reported an improvement in BMC with vitamin D supplementation in children on AEDs. No reports on changes in BMD among users of newer AEDs are available. In conclusion, more evidence is needed for the effects on BMD in children, especially for newer AEDs. The available studies have all been cross-sectional, and longitudianal studies are needed along with studies on potential interventions in children with decreased BMD.
癫痫患儿的骨矿物质含量（BMC）或骨密度（BMD）可能会降低，这可能是癫痫本身、引发癫痫的疾病或癫痫治疗的结果。本文研究了抗癫痫药物（AEDs）对儿童骨密度的影响。对PubMed进行系统检索后，得到了14篇描述使用AEDs儿童骨密度变化的论文。对于苯妥英钠，一项研究未显示股骨骨密度降低，而另一项研究报告全身和脊柱骨密度降低，但仅在使用苯妥英钠超过2年的情况下。苯妥英钠与生酮饮食联合使用时，前臂BMC降低。对于苯巴比妥，一项研究显示脊柱和全身骨密度降低，但仅在使用苯巴比妥超过2年的人群中出现。有六项关于卡马西平的研究，这些研究均未显示任何骨骼部位的骨密度降低。对于丙戊酸盐，结果不一；两项研究报告脊柱骨密度降低，而另外两项研究则未发现降低。两项研究报告丙戊酸盐使用者髋部骨密度降低，而另一项研究未发现降低。关于丙戊酸盐使用者前臂骨密度的三项研究均描述骨密度降低。三项研究报告补充维生素D可改善使用AEDs儿童的BMC。尚无关于新型AEDs使用者骨密度变化的报告。总之，关于对儿童骨密度的影响，尤其是新型AEDs，需要更多证据。现有的研究均为横断面研究，需要进行纵向研究以及对骨密度降低儿童的潜在干预措施的研究。
