Griepp Daniel W, Kim David J, Ganz Marc, Dolphin Eugene J, Sotudeh Nadia, Burekhovich Steven A, Naziri Qais
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA; College of Medicine, New York Institute for Technology, Old Westbury, New York, USA.
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA.
Epilepsy Res. 2021 Jul;173:106619. doi: 10.1016/j.eplepsyres.2021.106619. Epub 2021 Mar 19.
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.
癫痫可使用抗癫痫药物（AEDs）进行治疗，据报道这些药物会降低骨矿物质密度（BMD）。目前的数据相互矛盾且变化不定，关于AEDs的使用时长或特定的AEDs，如细胞色素P450酶诱导剂（EIAEDs）与非酶诱导剂（NEIAEDs）药物如何影响骨密度，人们所知甚少。我们试图系统地回顾因使用AEDs导致的骨密度变化，以确定报告中的趋势。
通过医学文献数据库（PubMed）、荷兰医学文摘数据库（EMBASE）和考克兰图书馆数据库进行文献检索。筛选出报道了与AEDs相关的骨密度测量结果的同行评审文章。
26项研究符合纳入标准。多项严格对照研究表明，长期治疗导致的骨密度损失最为显著。卡马西平对骨骼健康产生不利影响的报道最为频繁，而拉莫三嗪似乎表现出最强的骨骼保护作用。骨转换的血清生化标志物与测量的骨密度变化没有显著相关性。
本研究提供的证据表明，长期AED治疗是骨密度损失的最重要风险因素。此外，几乎没有确凿证据支持EIAEDs作为一个类别比NEIAEDs对骨骼更有害，此前多项研究曾提出过这种观点。由于在AED治疗的最初几年不太可能观察到较低的骨密度，因此早期临床对显著骨密度损失的担忧可能没有必要。此外，骨转换的血清标志物在评估服用AEDs患者的骨密度变化时在临床上并不可靠。
