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The effect of topiramate monotherapy on bone mineral density and markers of bone and mineral metabolism in premenopausal women with epilepsy.

Abstract

PURPOSE
To investigate the effect of topiramate on bone mass and metabolism in premenopausal women with epilepsy.
METHODS
Thirty-six women on long-term (at least 1 year) topiramate monotherapy were compared with 36 women taking carbamazepine, 32 women taking valproate, and 36 age- and sex-matched controls. Subjects completed bone mineral density (BMD) studies. Serum was analyzed for indices of bone metabolism.
KEY FINDINGS
BMD Z-scores, and serum 25-hydroxyvitamin D and 1alpha,25-dihydroxyvitamin D(3) concentrations did not differ among the groups. Serum calcium concentrations were significantly lower in patients receiving topiramate than in those receiving valproate, and in patients receiving carbamazepine than in those receiving valproate and controls. Patients taking topiramate had lower levels of parathyroid hormone compared with controls and those taking carbamazepine or valproate. Patients receiving topiramate had higher levels of bone-specific alkaline phosphatase and osteocalcin when compared with controls and higher levels of C-terminal telopeptide of type 1 collagen when compared with those taking carbamazepine or valproate. Patients receiving carbamazepine had higher levels of bone-specific alkaline phosphatase compared with controls and those receiving valproate. Serum bicarbonate concentrations were significantly lower in patients receiving topiramate than in the other groups.
SIGNIFICANCE
Our results demonstrate that use of topiramate is associated with lower parathyroid hormone and bicarbonate concentrations along with mild hypocalcemia and increased bone turnover, which suggests that topiramate may have long-term effects on bone.

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  • Publisher Full Text

    • Authors

    Heo K, Rhee Y, Lee HW, Lee SA, Shin DJ, Kim WJ, Song HK, Song K, Lee BI

    Institution

    Department of Neurology, Yonsei University College of Medicine, Seodaemungu, Seoul, Korea. kheo@yuhs.ac

    Source

    Epilepsia 52:10 2011 Oct pg 1884-9

    MeSH

    Adult
    Alkaline Phosphatase
    Anticonvulsants
    Bicarbonates
    Bone Density
    Bone and Bones
    Calcification, Physiologic
    Calcitriol
    Calcium
    Carbamazepine
    Epilepsy
    Female
    Fructose
    Humans
    Valproic Acid
    Vitamin D

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    21692779