Effets osseux des antiépileptiques

Abstract: Antiepileptic drugs are more used today for the treatment of epilepsy and other diseases as psychiatric disorders and chronic pain. An increased risk of fracture has been reported in cross-sectional and longitudinal studies in epileptic patients treated with antiepileptic drugs. Longitudinal studies in subjects older than 65 years show that antiepileptic drugs are associated with an increase risk of bone loss. Although many studies have been adjusted for a number of confounders, none have addressed whether the disease or condition for which the treatment was prescribed is responsible for the fracture. A potential mechanism is the increase catabolism of vitamin D due to hepatic induction of the P-450 cytochrome (CYP 450). However, the mechanisms of antiepileptic drugs-induced bone loss appears to be multiple, and all types of antiepileptic drugs are potentially implicated. There is limited data regarding the newer antiepileptic drugs. Although there are no consensus guidelines, adult patients receiving long-term antiepileptic drugs require a screening for osteoporosis and measurements of serum calcium, phosphate, alkaline phosphatase, and vitamin D. [Copyright &y& Elsevier]