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Vitamin D, calcium improved BMD in patients treated with antiepileptic drugs
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More than 69% of men taking antiepileptic drugs experienced improvements in bone mineral density after supplementation with calcium and vitamin D or calcium and vitamin D plus risedronate, according to recently published data.
“Long-term use of [antiepileptic drugs] is associated with loss of bone mass and increased risk of osteoporosis,” Antonio A. Lazzari, MD, FACR, CCD, of the VA Boston Healthcare System, said in a press release. “Our study is the first longitudinal trial of a bisphosphonate (risedronate), along with calcium and vitamin D supplementation, in preventing and treating bone loss in male veterans with epilepsy receiving [antiepileptic drug] therapy.”
For the Antiepileptic Drug and Osteoporosis Prevention Trial (ADOPT), Lazzari and colleagues randomly assigned 80 male veterans with chronic epilepsy who were being treated with antiepileptic drugs, including phenytoin, phenobarbital, sodium valproate and carbamazepine, for a minimum of 2 years to risedronate 35 mg or placebo. All participants also received calcium and vitamin D supplementation. The researchers used DXA to assess differences in total body, bilateral proximal femora and anterioposterior lumbar spine BMD from baseline to 1 to 2 years after study enrollment.
Of the 80 patients enrolled, 53 completed the study. Vitamin D and calcium supplementation significantly improved BMD from baseline in 69% of patients in the placebo group and 70% of those in the risedronate group. At the anterioposterior lumbar spine measured at L1 to L4, however, mean BMD increased significantly more in the risedronate group (1.267 g/cm2 to 1.332 cm2) compared with the placebo group (1.229 g/cm2 to 1.245 g/cm2; P=.0066).
Results also showed nonsignificant changes in total body BMD or at the proximal bilateral femora in both groups.
Additional data showed that incidence of fracture was higher for patients receiving placebo compared with risedronate, with five vertebral fractures occurring in the placebo group and one nonvertebral fracture occurring in the risedronate group.
“Our findings suggest calcium and vitamin D with or without risedronate improve bone density in epilepsy patients taking [antiepileptic drugs]. However, five new vertebral fractures were observed in the placebo group and none in the active medication group. Adding risedronate to the supplements appears to prevent new fractures in this group of veterans,” Lazzari said.
Disclosure: The researchers report no relevant financial disclosures.
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