EFFECTS OF LEVETIRACETAM AND TOPIRAMATE ON BONE HEALTH IN ADULTS, USING BONE SPECIFIC BIOMARKERS
Abstract
Purpose: Adverse drug reactions [ADRs] are important to monitor when medications are administered for chronic illnesses such as epilepsy/migraine particularly with recently approved widening indications for antiepileptic drugs [AEDs]. Therefore it is essential to recognize the potential of these AEDs to induce bone loss, as an adverse effect. Since osteoporosis is one of the well-known complications following the administration of older generation AEDs our aim was to quantify and compare the effects of newer AEDs - levetiracetam [LEV] and topiramate [TPM] monotherapy, on bone health using bone biomarkers viz. - serum cross laps, osteocalcin, vit. D and parathormone [PTH].
Method: 76 patients with epilepsy/migraine between 18-45 years of age, receiving LEV or TPM monotherapy for < 1 month with no co-morbid conditions were included. Serum samples were collected at baseline, 3rd, and 6th months. Samples were analyzed for serum cross laps, osteocalcin, Vit D, and PTH using Electrochemiluminescence. The levels of bone biomarkers were compared across time.
Results: The mean age of patients was 28.60 ± 6.60 [Mean ± SD] years with 60.78% females. Patients who received TPM complained of bone-related side effects which were significantly greater compared to LEV. There was no significant difference in levels of bone biomarkers over a period of six months and did not notice any difference between LEV and TPM.
Conclusion: The use of LEV and TPM as monotherapy in the treatment of epilepsy/ migraine over a period of six months was not associated with adverse influence on bone health.
Downloads
References
2. Alison M. Pack. The impact of long term antiepileptic drug use on bone health. Advanced studies in medicine. 2008.5: S567-S571
3. Alberto V, Giangennaro C, Pasquale P, Angelika M, Francesco C. Bone, and calcium metabolism and antiepileptic drugs. Clinical neurology and neurosurgery.2010.112:1-10.
4. Leppik IE .Managing your epilepsy [1st edition]. Handbooks in health care company; 2000, 5 - 42.
5. CecilieJohannessen Landmark. Antiepileptic Drugs in Non-Epilepsy Disorders- Relations between Mechanisms of Action and Clinical Efficacy. CNS Drugs. 2008.2[1]:27-47.
6. Danilo Antonio Baltieri, Fabio Ruiz Daróa, Philip LeiteRibeiroa, Arthur Guerra de Andrad. Effects of topiramate or naltrexone on tobacco use among male alcohol-dependent outpatients. Drug and Alcohol Dependence. 2009.105: 33–41.
7. Verrotti A, Coppola G, Parisi P, Mohn A, Chiarelli F. Bone and calcium metabolism and antiepileptic drugs. Clin Neurol Neurosurg. 2010.112:1-10
8. Pack AM, Morrell MJ. Epilepsy and bone health in adults. Epilepsy behave. 2005.5[2]: S24-S29.
9. Holick MF, Krane SM. Introduction to bone and mineral metabolism. In: Harrison’s principles of internal medicine [15]. Harrison’s principles of internal medicine 15th edition.2001.2192-2194.
10. Ray BK, Bhattacharya S, Kundu TN, Saha SR, Das SK. Epidemiology of epilepsy -Indian Perspective. J Ind Med Assoc. 2002.100: 322-26.
11. Kyoung Heo, Yumie Rhee, HyangWoon Lee et.al. The Effect of Topiramate monotherapy on Bone Mineral Density and Markers of Bone and mineral metabolism in premenopausal women. Epilepsia. 2011. 52[10]; 1884 – 1889.
12. Baker GA, Jacoby A, Buck D, Stalgis C, Monnet D. Quality of life of people with epilepsy: a European study. Epilepsia. 1997.38:353-62.
13. Han Le,PeerTfelt-Hansen, Axel Skytthe, Kirsten Ohm Kyvik, JesOlesen. Association between migraine, lifestyle and socioeconomic factors: a population-based cross-sectional study. J Headache Pain. 2011. 12:157–172.
14. Lise sofie, Nissen-Meyer, Sigrid S, Erik T, Leif Gjerstad, Finn PR et al. How can antiepileptic drugs affect bone mass, structure and metabolism? Lessons from animal studies. Seizure. 2008.17; 187-191.
15. Simona Alexandra Beniczky, JaninaViken, Lars Thorbjorn, Noemi Becser Anderson. Bone mineral density in adult patients’ treated with antiepileptic drugs. Seizure. 2012; 21:471-472.
16. Dae Lim Koo, EunYeonJoo, Dae Young Kim, Deung Bong Hong. Effects of levetiracetam as monotherapy on bone mineral density and biochemical markers of bone metabolism in patients with epilepsy. Epilepsy research.2012. 104[1-2]:134-9.
17. Imran Ali, Nabeel A, Megan Orris, Terrance Horrigan, Gretchen ET. Migraine Prophylaxis with Topiramate and bone health in women. Headache. 2011.613-16.
