Assessment of bone mineral density in epileptic patients with long-term antiepileptic therapy: pilot data

Currently, there are numerous anticonvulsants with a favorable pharmacological profile and high safety are available. However, there is still a risk of drug-induced adverse events during long-term administration of antiepileptic therapy. One of the most unfavorable changes in bone tissue associated with anticonvulsant use is osteoporotic disorders, which result in a loss of bone density, making the bones more fragile and prone to fractures. The problem of decreased bone mineral density and frequent fractures in patients with epilepsy is an important and understudied issue that significantly reduces quality of life and involves significant economic costs for the treatment and rehabilitation of epileptic patients. Studying the interaction between osteoporosis and epilepsy is of great importance for the development of effective methods for timely diagnosis, treatment and prevention of bone metabolism disorders. This article presents pilot results of a study to investigate the effect of antiepileptic therapy on mineral metabolism and bone density. The aim of the study: to evaluate bone mineral density in adult patients with epilepsy long-term receiving antiepileptic therapy. Materials and methods. Thirty-eight adult patients with epilepsy taking antiepileptic drugs for a long time were examined. All patients underwent general clinical, neurologic examination and densitometric study by quantitative computed tomography at three points (L1, L2 and femoral neck). Results. Decreased bone mineral density was found in 34.2% of the patients. Of them, 29% had osteopenia and 5.2% - osteoporosis. The change in mineral density was observed at a median duration of antiepileptic therapy of 8 years. ROC analysis showed that bone mineral density decreased statistically significantly with increasing duration of anitconvulsant therapy (SROC 0.929±0.052; 95% CI: 0.827-1.000). Correlation analysis revealed a markedly close association (ρ = -0.626, p < 0.001) between bone mineral density and duration of antiepileptic therapy. Conclusion. The results of the study confirm the effect of antiepileptic therapy on bone mineral density. And show that the probability of developing osteopenia and osteoprosis with longer duration of anticonvulsant therapy is higher than in the general population. The study of the effects of antiepileptic drugs on bone metabolism has important clinical implications for effective strategies for prescribing antiepileptic therapy in epileptic patients and requires further research.