Lee Richard, Lyles Kenneth, Sloane Richard, Colón-Emeric Cathleen
1 Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC.
Endocr Pract. 2012 Sep 14:1-22. doi: 10.4158/EP12119.OR.
Previous studies have shown an association between the use of traditional anticonvulsants (e.g. phenytoin, carbamazepine, valproate) and decreased bone mineral density (BMD). However, there are limited data regarding the effects of newer anticonvulsants (e.g. gabapentin, levetiracetam, topiramate) on BMD. The aim of this study was to examine the association between the duration of anticonvulsant exposure and BMD, focusing on newer anticonvulsants.
This is a retrospective cohort study of patients at a single Veterans Affairs (VA) Medical Center. Longitudinal prescription histories, medical comorbidities, vital statistics, and BMD assessments by dual-energy X-ray absorptiometry (DXA), were abstracted from the computerized medical record. Among 1779 individuals with a DXA scan within the study period, 560 were prescribed at least one anticonvulsant.
After adjusting for multiple confounders (including age, gender, body mass index, medical comorbidities, and other medication use), higher duration of use of newer, nonenzyme-inducing anticonvulsants was associated with a higher T-score at the total hip (0.05 standard deviations [SD], p = 0.02) and lumbar (0.10 SD, p < 0.01), compared to non-users referred for BMD assessment. In contrast, higher duration of use of traditional anticonvulsants had a lower total hip T-score. Furthermore, patients prescribed newer, nonenzyme-inducing anticonvulsants were less likely to have a diagnosis of osteoporosis at the lumbar spine (OR 0.80, 95% CI: 0.68 - 0.95), femoral neck (OR 0.82, 95% CI: 0.69 - 0.98), and total hip (OR 0.74, 95% CI: 0.56 - 0.98).
The results suggest that newer anticonvulsant medications are not associated with lower BMD.
既往研究表明，使用传统抗惊厥药（如苯妥英、卡马西平、丙戊酸盐）与骨矿物质密度（BMD）降低之间存在关联。然而，关于新型抗惊厥药（如加巴喷丁、左乙拉西坦、托吡酯）对BMD影响的数据有限。本研究的目的是探讨抗惊厥药暴露时长与BMD之间的关联，重点关注新型抗惊厥药。
这是一项针对单一退伍军人事务（VA）医疗中心患者的回顾性队列研究。从计算机化病历中提取纵向处方史、医疗合并症、生命统计数据以及通过双能X线吸收法（DXA）进行的BMD评估。在研究期间进行DXA扫描的1779名个体中，560人至少开具了一种抗惊厥药。
在调整多个混杂因素（包括年龄、性别、体重指数、医疗合并症和其他药物使用情况）后，与因BMD评估而转诊的未使用者相比，新型非酶诱导抗惊厥药使用时间越长，全髋部T值越高（0.05标准差[SD]，p = 0.02），腰椎T值越高（0.10 SD，p < 0.01）。相比之下，传统抗惊厥药使用时间越长，全髋部T值越低。此外，开具新型非酶诱导抗惊厥药的患者在腰椎（比值比[OR] 0.80，95%置信区间[CI]：0.68 - 0.95）、股骨颈（OR 0.82，95% CI：0.69 - 0.98）和全髋部（OR 0.74，95% CI：0.56 - 0.98）被诊断为骨质疏松的可能性较小。
结果表明，新型抗惊厥药物与较低的BMD无关。
