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Objective <p>The study aimed to evaluate the effect of&#xa0;antiseizure medications (ASMs)&#xa0;on bone health in children with drug-naive epilepsy and its associated risk factors over a one-year follow-up period.</p> Methods <p>A prospective study enrolled children aged 5–15&#xa0;years with drug-naïve epilepsy. At baseline and after one year of treatment with ASMs, bone mineral density (BMD) was measured by Dual energy X-ray absorptiometry (DXA), and bone metabolism markers (calcium, phosphorus, alkaline phosphatase, vitamin D, intact parathyroid hormone (i-PTH)). The primary outcome was the change in&#xa0;BMD&#xa0;after&#xa0;one year of treatment;&#xa0;secondary outcomes included&#xa0;BMD change&#xa0;in mono- and polytherapy, and changes in bone metabolism markers and risk factors for reduced BMD.</p> Results <p>Sixty-five patients (40 boys) with mean (SD)&#xa0;age&#xa0;8.6 (2.8) years completed&#xa0;one-year follow-up;&#xa0;50 (77%) had generalized epilepsy, and 42 (65%) had an unknown etiology. 30&#xa0;(46%) and 35 (54%) children received monotherapy and polytherapy, respectively. At one-year follow-up, the median (Q1, Q3) BMD was significantly lower&#xa0;compared to baseline&#xa0;[0.623, (0.540,&#xa0;0.714) vs.&#xa0;0.656&#xa0;(0.582,&#xa0;0.745);&#xa0;<i>P</i> &lt; 0.001]. Likewise, the&#xa0;median (Q1, Q3) DXA Z-score was significantly lower&#xa0;compared to the baseline&#xa0;[0.20, (− 0.50,&#xa0;0.60) vs.&#xa0;0.50, (0.20,&#xa0;0.80);&#xa0;<i>P</i> &lt; 0.001]. At one-year, median (Q1, Q3) serum 25-OH vitamin D levels [20, (17,&#xa0;27) vs. 26, (23,&#xa0;33.5);&#xa0;<i>P</i> &lt; 0.001] and i-PTH [34, (24,&#xa0;56) vs. 31, (20.50,&#xa0;44);&#xa0;<i>P</i> = 0.008] had&#xa0;significantly reduced&#xa0;and increased, respectively.&#xa0;Both mono- and polytherapy subgroups showed significant reduction in BMD, DXA z-score, and serum 25-OH&#xa0;vitamin D levels. Multivariate analysis identified male gender as an independent risk factor for low BMD [adjusted odds ratio 4.46, (95% CI 1.16–17.21);&#xa0;<i>P</i> = 0.030).</p> Conclusion <p>Antiseizure medications&#xa0;affect the&#xa0;bone health adversely in children with drug-naïve epilepsy, leading to significant reductions in BMD and altered bone metabolism markers.</p>

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A Prospective Study on the Effect of Antiseizure Medications on the Bone Mineral Density of Children with Drug-Naïve Epilepsy

  • 期刊论文

  • 发表日期：

    2026年1月14日

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  • Aleesha Kanakuzhi Aliyar,
  • Ramachandran Rameshkumar,
  • Tamil Selvan,
  • Jayaprakash Sahoo,
  • Ananthanarayanan Kasinathan

摘要

Objective

The study aimed to evaluate the effect of antiseizure medications (ASMs) on bone health in children with drug-naive epilepsy and its associated risk factors over a one-year follow-up period.

Methods

A prospective study enrolled children aged 5–15 years with drug-naïve epilepsy. At baseline and after one year of treatment with ASMs, bone mineral density (BMD) was measured by Dual energy X-ray absorptiometry (DXA), and bone metabolism markers (calcium, phosphorus, alkaline phosphatase, vitamin D, intact parathyroid hormone (i-PTH)). The primary outcome was the change in BMD after one year of treatment; secondary outcomes included BMD change in mono- and polytherapy, and changes in bone metabolism markers and risk factors for reduced BMD.

Results

Sixty-five patients (40 boys) with mean (SD) age 8.6 (2.8) years completed one-year follow-up; 50 (77%) had generalized epilepsy, and 42 (65%) had an unknown etiology. 30 (46%) and 35 (54%) children received monotherapy and polytherapy, respectively. At one-year follow-up, the median (Q1, Q3) BMD was significantly lower compared to baseline [0.623, (0.540, 0.714) vs. 0.656 (0.582, 0.745); P < 0.001]. Likewise, the median (Q1, Q3) DXA Z-score was significantly lower compared to the baseline [0.20, (− 0.50, 0.60) vs. 0.50, (0.20, 0.80); P < 0.001]. At one-year, median (Q1, Q3) serum 25-OH vitamin D levels [20, (17, 27) vs. 26, (23, 33.5); P < 0.001] and i-PTH [34, (24, 56) vs. 31, (20.50, 44); P = 0.008] had significantly reduced and increased, respectively. Both mono- and polytherapy subgroups showed significant reduction in BMD, DXA z-score, and serum 25-OH vitamin D levels. Multivariate analysis identified male gender as an independent risk factor for low BMD [adjusted odds ratio 4.46, (95% CI 1.16–17.21); P = 0.030).

Conclusion

Antiseizure medications affect the bone health adversely in children with drug-naïve epilepsy, leading to significant reductions in BMD and altered bone metabolism markers.