Rahimdel Abolghasem, Dehghan Ali, Moghadam Mahboubeh Abolhassani, Ardekani Ali Mellat
Neurologist, Associated Professor, Neurology Department, Shahid Sadoughi Hospital, Yazd University of Medical Science, Yazd, Iran.
Rheumatologist, Assistant Professor, Internal Medicine Department, Shahid Sadoughi Hospital, Yazd University of Medical Science, Yazd, Iran.
Electron Physician. 2016 Nov 25;8(11):3257-3265. doi: 10.19082/3257. eCollection 2016 Nov.
Chronic antiepileptic therapy has been associated with metabolic bone diseases including osteomalacia and osteoporosis. The aim of this study was to determine frequency of changes in biochemical and bone mineral density (BMD) in adults receiving valproaic acid (VPA) & carbamazepine (CBZ).
In a cross sectional study evaluating adults (age 20-50 y) epileptic patients receiving valproic acid or carbamazepine for at least 2 years. This study was conducted from May 2014 to May 2015 in Shahid Sadoughi Hospital of Yazd University of Medical Science, Yazd, Iran. Bone metabolism was evaluated by measurement of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) and parathormone hormone (PTH), BMD at lumbar and femoral measured by dual energy X ray absorptiometry (DXA). SPSS software (version 18) was used for data analysis. The t-test was used for quantitative data, and the chi-squared test was used for the qualitative variables.
Eighty two epileptic patients (mean age: 31.67±10.69 year) treated with either carbamazepine (n=41) or valproate sodium (n=41) were studied. Normal serum Ca and P levels were observed in 98.8% and 97.6% of patients respectively. Serum ALP and PTH were normal in 97.6% and 97.6% of patients. Means of Ca and P in CBZ group were significantly lower than VPA group (Ca: 9.02 vs. 9.1, p-value: 0.03 and P: 3.54 vs. 3.76 p-value: 0.004). BMD values at lumbar spine were not significant in either group (T. score CBZ: -0.43± 0.744 vs. T. score VPA: -0.615± 0.904 and p-value: 0.333) and were significantly higher than Iranian normal population BMD value at femoral neck in CBZ group was lower than VPA group (T. score CBZ: -0.707± 0.896 vs. T. score VPA: - 0.297± 0.850 p-value: 0.04). Dosage of CBZ and VPA did not correlate with BMD and biochemical parameters. Duration of CBZ use had correlation with increased ALP and duration of VPA use had correlation with decreased BMD in adult patients.
long term anti-epileptic drug treatment either with CBZ and VPA which has unknown effects on skeletal mineralization and induces a state of decreased bone mineral density BMD values at femoral neck were significant in CBZ group Therefore regular screening for monitoring of biochemical markers of bone turnover and BMD with DXA during the treat period is recommended. In addition, Ca supplement could be considered for all patients with epilepsy upon initiation of CBZ and VPA therapy.
长期抗癫痫治疗与包括骨软化症和骨质疏松症在内的代谢性骨病有关。本研究的目的是确定接受丙戊酸（VPA）和卡马西平（CBZ）治疗的成年人中生化指标和骨密度（BMD）变化的频率。
在一项横断面研究中，评估年龄在20至50岁之间、接受丙戊酸或卡马西平治疗至少2年的癫痫患者。本研究于2014年5月至2015年5月在伊朗亚兹德医科大学沙希德·萨多吉医院进行。通过测量血清钙（Ca）、磷（P）、碱性磷酸酶（ALP）和甲状旁腺激素（PTH）评估骨代谢，采用双能X线吸收法（DXA）测量腰椎和股骨的骨密度。使用SPSS软件（版本18）进行数据分析。t检验用于定量数据，卡方检验用于定性变量。
研究了82例接受卡马西平（n = 41）或丙戊酸钠（n = 41）治疗的癫痫患者（平均年龄：31.67±10.69岁）。分别有98.8%和97.6%的患者血清Ca和P水平正常。97.6%的患者血清ALP和PTH正常。卡马西平组的Ca和P均值显著低于丙戊酸组（Ca：9.02对9.1，p值：0.03；P：3.54对3.76，p值：0.004）。两组腰椎的骨密度值均无显著差异（卡马西平组T值：-0.43±0.744对丙戊酸组T值：-0.615±0.904，p值：0.333），且显著高于伊朗正常人群。卡马西平组股骨颈的骨密度值低于丙戊酸组（卡马西平组T值：-0.707±0.896对丙戊酸组T值：-0.297±0.850，p值：0.04）。卡马西平和丙戊酸的剂量与骨密度和生化参数无关。在成年患者中，卡马西平的使用时间与ALP升高相关，丙戊酸的使用时间与骨密度降低相关。
长期使用卡马西平和丙戊酸进行抗癫痫药物治疗对骨骼矿化有未知影响，并导致骨密度降低。卡马西平组股骨颈的骨密度值有显著差异。因此，建议在治疗期间定期进行筛查，监测骨转换生化标志物和使用DXA测量骨密度。此外，在开始卡马西平和丙戊酸治疗时，可考虑对所有癫痫患者补充钙剂。
