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Evaluation of bone mineral density in children receiving carbamazepine or valproate monotherapy.
Acta Paediatr Taiwan. 2007 Nov-Dec; 48(6):317-22.AP

Abstract

BACKGROUND

Antiepileptic drugs have been shown to be associated with a lowering of bone mineral density in childhood and adolescence, which are critical periods of skeletal mineralization. A lower peak bone mass attained at the end of adolescence is associated with greater involutional osteoporosis and risk for fracture in the elderly. Our purpose was to evaluate the effects of carbamazepine and valproate monotherapy on bone mineral density in children in Taiwan.

METHODS

From November 1995 to April 2005, forty-two children with uncomplicated epilepsy, who were treated with either carbamazepine (n=21) or valproate (n=21) monotherapy for more than 6 months, were enrolled in this study. All subjects were 5 to 18 years of age, seizure-free for 5 months or more, with normal daily activity, and normal diet. Lumbar bone mineral density of L1 to L4 was measured by dual-energy X-ray absorptiometry.

RESULTS

The mean serum levels of carbamazepine and valproate were 5.12 +/- 2.15 mcg/ml and 49.61 +/- 20.84 mcg/ml, respectively. Treatment durations were 37.05 +/- 31.11 months and 22.86 +/- 18.84 months, respectively. The serum levels of calcium and phosphate in both groups were within therapeutic range. The serum level of alkaline phosphatase was significantly higher in the carbamazepine group (264.71 +/- 66.91, U/L) than in the valproate group (179.48 +/- 79.37, U/L). Three patients (140%) had bone mineral density Z-score of -2.0 or lower in the carbamazepine-treated group, but none in the valproate-treated group (p=0.232). Comparing the Z-score in carbamazapine- and valproate-monotherapy children, 7 (33%) had Z-score of -1.5 or lower in the carbamazepine-treated group, and none in the valporate-treated group had Z-score of -1.5 or lower (p=0.009). Four (57%) patients in the 7 carbamazepine-treated children with Z-score of -1.5 or lower had serum drug level lower than therapeutic range.

CONCLUSIONS

Children receiving carbarmazepine monotherapy had increased frequency of lower bone density than children receiving valproate monotherapy.

Authors+Show Affiliations

Division of Pediatric Neurology, Department of Diagnostic Imaging, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18437965

Citation

Chou, I-Jun, et al. "Evaluation of Bone Mineral Density in Children Receiving Carbamazepine or Valproate Monotherapy." Acta Paediatrica Taiwanica = Taiwan Er Ke Yi Xue Hui Za Zhi, vol. 48, no. 6, 2007, pp. 317-22.
Chou IJ, Lin KL, Wang HS, et al. Evaluation of bone mineral density in children receiving carbamazepine or valproate monotherapy. Acta Paediatr Taiwan. 2007;48(6):317-22.
Chou, I. J., Lin, K. L., Wang, H. S., & Wang, C. J. (2007). Evaluation of bone mineral density in children receiving carbamazepine or valproate monotherapy. Acta Paediatrica Taiwanica = Taiwan Er Ke Yi Xue Hui Za Zhi, 48(6), 317-22.
Chou IJ, et al. Evaluation of Bone Mineral Density in Children Receiving Carbamazepine or Valproate Monotherapy. Acta Paediatr Taiwan. 2007 Nov-Dec;48(6):317-22. PubMed PMID: 18437965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of bone mineral density in children receiving carbamazepine or valproate monotherapy. AU - Chou,I-Jun, AU - Lin,Kuang-Lin, AU - Wang,Huei-Shyong, AU - Wang,Chao-Jan, PY - 2008/4/29/pubmed PY - 2008/5/14/medline PY - 2008/4/29/entrez SP - 317 EP - 22 JF - Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi JO - Acta Paediatr Taiwan VL - 48 IS - 6 N2 - BACKGROUND: Antiepileptic drugs have been shown to be associated with a lowering of bone mineral density in childhood and adolescence, which are critical periods of skeletal mineralization. A lower peak bone mass attained at the end of adolescence is associated with greater involutional osteoporosis and risk for fracture in the elderly. Our purpose was to evaluate the effects of carbamazepine and valproate monotherapy on bone mineral density in children in Taiwan. METHODS: From November 1995 to April 2005, forty-two children with uncomplicated epilepsy, who were treated with either carbamazepine (n=21) or valproate (n=21) monotherapy for more than 6 months, were enrolled in this study. All subjects were 5 to 18 years of age, seizure-free for 5 months or more, with normal daily activity, and normal diet. Lumbar bone mineral density of L1 to L4 was measured by dual-energy X-ray absorptiometry. RESULTS: The mean serum levels of carbamazepine and valproate were 5.12 +/- 2.15 mcg/ml and 49.61 +/- 20.84 mcg/ml, respectively. Treatment durations were 37.05 +/- 31.11 months and 22.86 +/- 18.84 months, respectively. The serum levels of calcium and phosphate in both groups were within therapeutic range. The serum level of alkaline phosphatase was significantly higher in the carbamazepine group (264.71 +/- 66.91, U/L) than in the valproate group (179.48 +/- 79.37, U/L). Three patients (140%) had bone mineral density Z-score of -2.0 or lower in the carbamazepine-treated group, but none in the valproate-treated group (p=0.232). Comparing the Z-score in carbamazapine- and valproate-monotherapy children, 7 (33%) had Z-score of -1.5 or lower in the carbamazepine-treated group, and none in the valporate-treated group had Z-score of -1.5 or lower (p=0.009). Four (57%) patients in the 7 carbamazepine-treated children with Z-score of -1.5 or lower had serum drug level lower than therapeutic range. CONCLUSIONS: Children receiving carbarmazepine monotherapy had increased frequency of lower bone density than children receiving valproate monotherapy. SN - 1608-8115 UR - https://www.unboundmedicine.com/medline/citation/18437965/Evaluation_of_bone_mineral_density_in_children_receiving_carbamazepine_or_valproate_monotherapy_ L2 - https://medlineplus.gov/bonedensity.html DB - PRIME DP - Unbound Medicine ER -