Duration matters: anticonvulsant therapy linked to bone loss in interim cross-sectional study

Abstract

BACKGROUND: Anticonvulsants are widely used in treating patients with mental and neurological disorders. Their long-term use increases the risk of a decrease in bone mineral density (BMD) and low-energy fractures. Despite the growing number of studies of drug-induced osteoporosis, the effect of anticonvulsants on bone microarchitecture remains poorly studied.

AIM: To study the effect of treatment duration with different generations of anticonvulsants on bone mineral density and fracture risk.

METHODS: We examined 100 adult patients with epilepsy who had been on anticonvulsants for more than 12 months and 58 healthy subjects who had never taken anticonvulsants. All the participants underwent a general clinical and neuropsychological assessment, as well as bone densitometry using quantitative computed tomography in three regions of interest (lumbar vertebrae L1, L2 and femoral neck).

RESULTS: BMD reductions were observed in 47 patients (47%) taking anticonvulsants and 29 (50%) subjects in the control group. The mean duration of anticonvulsant therapy was 8.7 years (SD=8.05) in patients with normal BMD, 10.7 years (SD=7.07) in patients with osteopenia, and 9.5 years (SD=5.24) in patients with osteoporosis. Age was found to significantly affect BMD, while the duration of anticonvulsant therapy affected it to a lesser extent. Patients taking first-generation anticonvulsants had lower BMD (p=0.018). ROC analysis confirmed the existence of a relationship between the duration of anticonvulsant therapy and the risk of fractures (p<0.001). The “duration of anticonvulsant therapy” threshold at the cut-off point corresponding to the highest Youden index value was 10 years.

CONCLUSION: Long-term treatment with conventional anticonvulsants adversely affects BMD and can lead to pathological bone resorption, increasing the risk of fractures in patients. New-generation anticonvulsants did not show any significant negative impact on BMD. The results of this study indicate the need for further research to better understand the effects of anticonvulsants on bone tissue.

Keywords

epilepsy / bone mineral density / osteoporosis / osteopenia / densitometry / anticonvulsants

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Funding

Russian Science FoundationРоссийский научный фонд(23-25-00104)

RIGHTS & PERMISSIONS

Sivakova N.A., Abramova I.V., Trukhina I.Y., Rybasova V.P., Sorokin M.Y., Kasyanov E.D., Lukina L.V., Mikhailov V.A., Mazo G.E.