Bone mineral status in ambulatory pediatric patients on long-term anti-epileptic drug therapy

Hirokazu Tsukahara, Kouki Kimura, Yukiko Todoroki, Yusei Ohshima, Masahiro Hiraoka, Yosuke Shigematsu, Yasuyo Tsukahara, Masakazu Miura, Mitsufumi Mayumi

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: For ambulatory pediatric outpatients, reports of abnormalities of bone metabolism associated with anti-epileptic drugs are inconsistent and may be difficult to interpret. Methods: The effects of long-term anti-epileptic therapy (mainly valproic acid and/or carbamazepine) on bone mineral status were evaluated in ambulatory epileptic patients (seven males and 11 females) aged 5.5-15.9 years. Bone mineral density (BMD) at the lumbar spine was measured by dual-energy X-ray absorptiometry and markers of bone and mineral metabolism were determined. Results: The mean BMD was decreased by 9% in our patients relative to the control, and five patients (all males) showed osteopenia, defined as BMD SD scores less than - 1.5. Serum levels of minerals, intact parathyroid hormone and 1α,25(OH)2 vitamin D were within the normal ranges. In most patients, serum levels of intact osteocalcin, carboxyterminal propeptide of type I procollagen and pyridinoline cross-linked telopeptide of type I collagen were reduced relative to the corresponding mean control values. The BB genotype by BsmI restriction fragment length polymorphism, associated with low BMD, was not found in our patients. The dietary calcium intake in the osteopenic patients was significantly lower than that of the non-osteopenic patients. Conclusions: Our results indicate that long-term anti-epileptic treatment induces a state of decreased bone turnover in children, resulting in osteopenia preferentially in males. The alterations may be due, at least in part, to direct effects of the drugs on bone cells; and that low calcium intake could be an aggravating factor for anti-epileptic-associated osteopenia.

Original languageEnglish
Pages (from-to)247-253
Number of pages7
JournalPediatrics International
Volume44
Issue number3
DOIs
Publication statusPublished - 2002
Externally publishedYes

Fingerprint

Minerals
Pediatrics
Bone and Bones
Drug Therapy
Bone Density
Metabolic Bone Diseases
Collagen Type I
Ergocalciferols
Dietary Calcium
Bone Remodeling
Osteocalcin
Carbamazepine
Photon Absorptiometry
Valproic Acid
Parathyroid Hormone
Serum
Restriction Fragment Length Polymorphisms
Pharmaceutical Preparations
Reference Values
Spine

Keywords

  • Bone markers
  • Bone metabolism
  • Calcium intake
  • Dual-energy X-ray absorptiometry
  • Long-term anti-epileptic treatment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Bone mineral status in ambulatory pediatric patients on long-term anti-epileptic drug therapy. / Tsukahara, Hirokazu; Kimura, Kouki; Todoroki, Yukiko; Ohshima, Yusei; Hiraoka, Masahiro; Shigematsu, Yosuke; Tsukahara, Yasuyo; Miura, Masakazu; Mayumi, Mitsufumi.

In: Pediatrics International, Vol. 44, No. 3, 2002, p. 247-253.

Research output: Contribution to journalArticle

Tsukahara, H, Kimura, K, Todoroki, Y, Ohshima, Y, Hiraoka, M, Shigematsu, Y, Tsukahara, Y, Miura, M & Mayumi, M 2002, 'Bone mineral status in ambulatory pediatric patients on long-term anti-epileptic drug therapy', Pediatrics International, vol. 44, no. 3, pp. 247-253. https://doi.org/10.1046/j.1442-200X.2002.01561.x
Tsukahara, Hirokazu ; Kimura, Kouki ; Todoroki, Yukiko ; Ohshima, Yusei ; Hiraoka, Masahiro ; Shigematsu, Yosuke ; Tsukahara, Yasuyo ; Miura, Masakazu ; Mayumi, Mitsufumi. / Bone mineral status in ambulatory pediatric patients on long-term anti-epileptic drug therapy. In: Pediatrics International. 2002 ; Vol. 44, No. 3. pp. 247-253.
@article{de37ed388dab45fbbe8b1f5a86c81ea3,
title = "Bone mineral status in ambulatory pediatric patients on long-term anti-epileptic drug therapy",
abstract = "Background: For ambulatory pediatric outpatients, reports of abnormalities of bone metabolism associated with anti-epileptic drugs are inconsistent and may be difficult to interpret. Methods: The effects of long-term anti-epileptic therapy (mainly valproic acid and/or carbamazepine) on bone mineral status were evaluated in ambulatory epileptic patients (seven males and 11 females) aged 5.5-15.9 years. Bone mineral density (BMD) at the lumbar spine was measured by dual-energy X-ray absorptiometry and markers of bone and mineral metabolism were determined. Results: The mean BMD was decreased by 9{\%} in our patients relative to the control, and five patients (all males) showed osteopenia, defined as BMD SD scores less than - 1.5. Serum levels of minerals, intact parathyroid hormone and 1α,25(OH)2 vitamin D were within the normal ranges. In most patients, serum levels of intact osteocalcin, carboxyterminal propeptide of type I procollagen and pyridinoline cross-linked telopeptide of type I collagen were reduced relative to the corresponding mean control values. The BB genotype by BsmI restriction fragment length polymorphism, associated with low BMD, was not found in our patients. The dietary calcium intake in the osteopenic patients was significantly lower than that of the non-osteopenic patients. Conclusions: Our results indicate that long-term anti-epileptic treatment induces a state of decreased bone turnover in children, resulting in osteopenia preferentially in males. The alterations may be due, at least in part, to direct effects of the drugs on bone cells; and that low calcium intake could be an aggravating factor for anti-epileptic-associated osteopenia.",
keywords = "Bone markers, Bone metabolism, Calcium intake, Dual-energy X-ray absorptiometry, Long-term anti-epileptic treatment",
author = "Hirokazu Tsukahara and Kouki Kimura and Yukiko Todoroki and Yusei Ohshima and Masahiro Hiraoka and Yosuke Shigematsu and Yasuyo Tsukahara and Masakazu Miura and Mitsufumi Mayumi",
year = "2002",
doi = "10.1046/j.1442-200X.2002.01561.x",
language = "English",
volume = "44",
pages = "247--253",
journal = "Pediatrics International",
issn = "1328-8067",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Bone mineral status in ambulatory pediatric patients on long-term anti-epileptic drug therapy

AU - Tsukahara, Hirokazu

AU - Kimura, Kouki

AU - Todoroki, Yukiko

AU - Ohshima, Yusei

AU - Hiraoka, Masahiro

AU - Shigematsu, Yosuke

AU - Tsukahara, Yasuyo

AU - Miura, Masakazu

AU - Mayumi, Mitsufumi

PY - 2002

Y1 - 2002

N2 - Background: For ambulatory pediatric outpatients, reports of abnormalities of bone metabolism associated with anti-epileptic drugs are inconsistent and may be difficult to interpret. Methods: The effects of long-term anti-epileptic therapy (mainly valproic acid and/or carbamazepine) on bone mineral status were evaluated in ambulatory epileptic patients (seven males and 11 females) aged 5.5-15.9 years. Bone mineral density (BMD) at the lumbar spine was measured by dual-energy X-ray absorptiometry and markers of bone and mineral metabolism were determined. Results: The mean BMD was decreased by 9% in our patients relative to the control, and five patients (all males) showed osteopenia, defined as BMD SD scores less than - 1.5. Serum levels of minerals, intact parathyroid hormone and 1α,25(OH)2 vitamin D were within the normal ranges. In most patients, serum levels of intact osteocalcin, carboxyterminal propeptide of type I procollagen and pyridinoline cross-linked telopeptide of type I collagen were reduced relative to the corresponding mean control values. The BB genotype by BsmI restriction fragment length polymorphism, associated with low BMD, was not found in our patients. The dietary calcium intake in the osteopenic patients was significantly lower than that of the non-osteopenic patients. Conclusions: Our results indicate that long-term anti-epileptic treatment induces a state of decreased bone turnover in children, resulting in osteopenia preferentially in males. The alterations may be due, at least in part, to direct effects of the drugs on bone cells; and that low calcium intake could be an aggravating factor for anti-epileptic-associated osteopenia.

AB - Background: For ambulatory pediatric outpatients, reports of abnormalities of bone metabolism associated with anti-epileptic drugs are inconsistent and may be difficult to interpret. Methods: The effects of long-term anti-epileptic therapy (mainly valproic acid and/or carbamazepine) on bone mineral status were evaluated in ambulatory epileptic patients (seven males and 11 females) aged 5.5-15.9 years. Bone mineral density (BMD) at the lumbar spine was measured by dual-energy X-ray absorptiometry and markers of bone and mineral metabolism were determined. Results: The mean BMD was decreased by 9% in our patients relative to the control, and five patients (all males) showed osteopenia, defined as BMD SD scores less than - 1.5. Serum levels of minerals, intact parathyroid hormone and 1α,25(OH)2 vitamin D were within the normal ranges. In most patients, serum levels of intact osteocalcin, carboxyterminal propeptide of type I procollagen and pyridinoline cross-linked telopeptide of type I collagen were reduced relative to the corresponding mean control values. The BB genotype by BsmI restriction fragment length polymorphism, associated with low BMD, was not found in our patients. The dietary calcium intake in the osteopenic patients was significantly lower than that of the non-osteopenic patients. Conclusions: Our results indicate that long-term anti-epileptic treatment induces a state of decreased bone turnover in children, resulting in osteopenia preferentially in males. The alterations may be due, at least in part, to direct effects of the drugs on bone cells; and that low calcium intake could be an aggravating factor for anti-epileptic-associated osteopenia.

KW - Bone markers

KW - Bone metabolism

KW - Calcium intake

KW - Dual-energy X-ray absorptiometry

KW - Long-term anti-epileptic treatment

UR - http://www.scopus.com/inward/record.url?scp=0036316126&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036316126&partnerID=8YFLogxK

U2 - 10.1046/j.1442-200X.2002.01561.x

DO - 10.1046/j.1442-200X.2002.01561.x

M3 - Article

C2 - 11982890

AN - SCOPUS:0036316126

VL - 44

SP - 247

EP - 253

JO - Pediatrics International

JF - Pediatrics International

SN - 1328-8067

IS - 3

ER -