Harrington M G, Hodkinson H M
Department of Geriatric Medicine, University College Hospital, London.
J R Soc Med. 1987 Jul;80(7):425-7. doi: 10.1177/014107688708000710.
Elderly psychiatric inpatients were studied to find the prevalence of osteomalacia in those taking anticonvulsant medication (n = 19) and a comparison group not taking these drugs (n = 37). Only one biopsy-proven case was discovered among the anticonvulsant group, and none in the comparison group. This was an unexpectedly low rate. The clinical and biochemical data (including alkaline and acid phosphatase isoenzymes) were further analysed to detect subclinical osteomalacia, but none was found. A difference between the two subgroups was found for total and liver alkaline phosphatase only. The possible explanations for these unexpected findings are discussed. The effect of anticonvulsants on vitamin D and bone metabolism is reviewed and the hypothesis that drug-induced changes in vitamin D metabolism are responsible for the bone changes described in earlier series is questioned.
对老年精神科住院患者进行了研究，以确定服用抗惊厥药物的患者（n = 19）和未服用这些药物的对照组（n = 37）中骨软化症的患病率。在抗惊厥药物组中仅发现1例经活检证实的病例，而对照组中未发现病例。这一发生率出乎意料地低。对临床和生化数据（包括碱性和酸性磷酸酶同工酶）进行了进一步分析，以检测亚临床骨软化症，但未发现此类病例。仅在总碱性磷酸酶和肝碱性磷酸酶方面发现两个亚组之间存在差异。讨论了这些意外发现的可能解释。综述了抗惊厥药物对维生素D和骨代谢的影响，并对药物引起的维生素D代谢变化是早期系列中所描述的骨变化的原因这一假设提出了质疑。
