Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
The Effect of Antiepileptic Drug Therapy on Bone Metabolism and its Relationship with Vitamin D Receptor Gene
Antiepileptik İlaç Tedavisinin Kemik Metabolizması Üzerine Etkisi ve D Vitamini Reseptör Geni ile İlişkisi
Özlem ÖZCANLI ÇAYa, Hepsen Mine SERİNa,b, Zehra Pınar KOÇc, Deniz EROLd, Erdal YILMAZa,e
Departments of
aPediatrics,
bPediatric Neurology,
cNuclear Medicine,
dMolecular Genetics,
ePediatric Cardiology, Fırat University Faculty of Medicine, Elazığ, TURKEY
Turkiye Klinikleri J Pediatr. 2019;28(3):121-7
doi: 10.5336/pediatr.2019-70621
Article Language: EN
Full Text
ABSTRACT
 Objective: The relationship between antiepileptic drugs and bone health and also the genetic aspect of this relationship is not clear and has been investigated in recent years. The aim of this study was to determine the effects of different antiepileptic drugs (AEDs) on bone mineral density results in long term follow up and to evaluate the relationship with the vitamin D profile (Bsml mutation) of the patients. Material and Methods: Eighty ambulatory patients (21 male, 59 female; mean age: 9.1±3.85 years) were included in the study. The patients were divided into four groups; Group 1 (levetiracetam), Group 2 (Carbamazepine), Group 3 (Valproic acid) and Group 4 (control). The plasma calcium, phosphorus, parathyroid hormone, alkaline phosphatase, vitamin D levels and bone mineral density values of femur and spine (L1-4) were compared. The patients were divided into two groups according to vitamin D receptor genes as the patients with Bsml mutations and without (wild type) Bsml mutations. Results: The difference between bone mineral density, Z score, phosphorus, parathyroid hormone, alkaline phosphatase and vitamin D levels of the patients in all four groups was not statistically significant. The phosphorus, parathyroid hormone, alkaline phosphatase and vitamin D levels and bone mineral density and Z score results of the patients with and without Bsml mutations were not significantly different. Conclusion: In this cross-sectional analysis, we found that the bone mineral status of the patients receiving different AEDs for a long time (> 2 years) was not significantly different. There was also no loss of bone mineral content in the patient group when compared with age-appropriate controls. According to the results of this study, Bsml polymorphism is not determinant in the progression of bone mineral loss.

Keywords: Antiepileptic drug; bone mineral density; epilepsy
ÖZET
 Amaç: Antiepileptik ilaçlar ile kemik sağlığı arasındaki ilişki, ayrıca bu ilişkinin genetik yönü net değildir ve son yıllarda araştırılmıştır. Bu çalışmanın amacı, farklı antiepileptik ilaçların uzun süreli takiplerde kemik mineral yoğunluğu sonuçları üzerine etkilerini belirlemek ve hastaların D vitamini profili (Bsml mutasyonu) ile ilişkilerini değerlendirmektir. Gereç ve Yöntemler: Çalışmaya 80 gezici hasta (21 erkek, 59 kız; yaş ort: 9,1±3,85 yıl) dahil edildi. Hastalar dört gruba ayrıldı; Grup 1 (Levetirasetam), Grup 2 (Karbamazepin), Grup 3 (Valproik asit) ve Grup 4 (kontrol). Plazma kalsiyum, fosfor, paratiroid hormonu, alkalen fosfataz, D vitamini düzeyleri ve femur ve vertebra (L1-4) kemik mineral yoğunluğu değerleri karşılaştırıldı. Hastalar D vitamin reseptörü genlerine göre Bsml mutasyonu olan ve (vahşi tip) Bsml mutasyonu olmayan olarak iki gruba ayrıldı. Bulgular: Dört grubun hepsinde kemik mineral yoğunluğu, Z skoru, fosfor, paratiroid hormonu, alkalen fosfataz ve D vitamini düzeyleri arasındaki fark istatistiksel olarak anlamlı değildi. Bsml mutasyonu olan ve olmayan hastaların fosfor, paratiroid hormonu, alkalen fosfataz, D vitamini düzeyleri ve kemik mineral yoğunluğu ve Z skorları arasında anlamlı fark yoktu. Sonuç: Bu kesitsel analizde, farklı antiepileptik ilaçları uzun süreli (>2 yıl) alan hastaların kemik mineral durumunun önemli ölçüde farklı olmadığını saptadık. Ayrıca yaşa uygun kontrol grubu ile kıyaslandığında hasta grubunda kemik mineral içeriği kaybı yoktu. Bu çalışmanın sonuçlarına göre Bsml polimorfizmi, kemik mineral kaybının ilerlemesinde belirleyici değildir.

Anahtar Kelimeler: Antiepileptik ilaç; kemik mineral yoğunluğu; epilepsi
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