July - September 2024, Volume 20, Issue 3

Buoso C, Pezzaioli LC, Gatta E, Bambini F, Silvestrini I, Delbarba A, Pirola I, Cappelli C

Antiepileptic Drugs and Bone Health: A Comprehensive Review and Metaanalysis

Acta Endo (Buc) 2024, 20 (3): 356-372
doi: 10.4183/aeb.2024.356

Context. Epilepsy and osteoporosis are closely related. The detrimental effect on bone by older generation of antiepileptic drugs (AEDs) is well known, but newer AEDs can also cause a decline in bone health. Objective. To provide a review on the impact of AEDs on bone mineral density, fractures and bone turnover markers and to analyze the effect of bone active treatments in epileptic patients. Methods. Medline (PubMed) and EMBASE were searched for studies about AEDs and bone health. The PRISMA statement was used. Results. Chronic use of AEDs is associated with alterations in bone metabolism, low bone mineral density values, and increased risk of fractures. These effects appear to be more associated to the use of enzyme-inducing AEDs. Supplements with vitamin D and bone active treatments may have benefits in terms of bone mineral density gain and of mortality risk. More studies are required to determine the impact of non-enzyme-inducing AEDs on bone health and to gather useful information about the management of osteoporosis therapy in epileptic patients. Conclusion. Chronic AED use has a significant impact on bone health; it is therefore necessary to evaluate in such individuals the claim to vitamin D and calcium supplements and bone active treatments.

Keywords: antiepileptic drugs, epilepsy, bone mineral density, fractures, bone turnover markers.

Correspondence: Carlo Cappelli, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, E-mail: carlo.cappelli@unibs.it