Characteristics of Bone Metabolism in Long-Term Administration of Anticonvulsants

Aim. To investigate parameters of mineral metabolism and bone mineral density in patients with long-term administration of anticonvulsants and healthy volunteers.

Design. Observational cross-sectional study with including two comparison groups.

Materials and methods. The study included 100 patients receiving anticonvulsants for more than 12 months and 58 healthy volunteers without antiepileptic drugs. Clinical neuropsychiatric examination, analysis of laboratory parameters of microelements and hormones associated with bone metabolism, and radiologic examination of bone mineral density using quantitative computed tomography (CT-densitometry) were performed on all study participants.

Results. The comparative analysis of laboratory parameters of micro-elements and hormones associated with bone metabolism revealed statistically significant differences in mean values of calcium ionized, vitamin D, free thyroxine and prolactin between the groups of patients receiving anticonvulsants and healthy participants (p (U) = 0.044, p (U) = 0.052, p (U) = 0.001, p (U) = 0.003, respectively). Statistically significantly higher levels of vitamin D deficiency (p (χ²) = 0.010, p (χ²) = 0.016) were found in patients with long-term use of anticonvulsants of different generations, in contrast to healthy individuals. The comparative analysis of vitamin D indices and changes in bone mineral density according to CT-densitometry in the groups of patients with long-term anticonvulsants and healthy participants showed no statistically significant differences (p (χ²) = 0.851, p (χ²) = 0.174, respectively). Patients receiving anticonvulsants had significantly higher levels of ionized calcium (p (χ²) < 0.001) compared to healthy participants, which is a marker of the prevalence of the process of osteoresorption over osteogenesis.

Conclusion. The results of the study confirm the negative effect of anticonvulsants on mineral metabolism and bone density. The results of the study may be important for the development of diagnostic and therapeutic measures in patients taking anticonvulsants for the early prevention of bone metabolism disorders and the development of osteoporosis.

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