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Neurology 2001;57:445-449
© 2001 American Academy of Neurology
Articles

Decreased bone mass and increased bone turnover with valproate therapy in adults with epilepsy

Y. Sato, MD;, I. Kondo, MD;, S. Ishida, MD;, H. Motooka, MD;, K. Takayama, MD;, Y. Tomita, MD;, H. Maeda, MD; and K. Satoh, MD

From the Departments of Internal Medicine (Dr. Sato) and Neuropsychiatry (Drs. Ishida, Motooka, Takayama, Tomita, and Maeda), Kurume University School of Medicine; and the Departments of Rehabilitation Medicine (Drs. Sato and Kondo) and Vascular Biology (Dr. Satoh), Institute of Brain Science, Hirosaki University School of Medicine, Japan.

Address correspondence and reprint requests to Dr. Yoshihiro Sato, Department of Rehabilitation Medicine, Institute of Brain Science, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan.

Background:— Bone loss and hypovitaminosis D are reported in patients taking antiepileptic drugs, but little is known about changes in bone and calcium metabolism from valproic acid (VPA).

Objective:— To assess the relationship of VPA to bone mass and calcium metabolism in 40 adults with epilepsy on long-term VPA monotherapy, 40 age- and sex-matched epileptic patients taking phenytoin (PHT), and 40 healthy control subjects. Bone mineral density (BMD) of the second metacarpal was determined as T- and Z-scores.

Results:— BMD reduction from control values was 14% (12% in men, 16% in women) with VPA and 13% (12% in men, 15% in women) with PHT. Among patients on VPA, nine (23%) had T-scores below -2.5 SD, suggesting osteoporosis; 15 (37%) had T-scores between -1 and -2.5 SD, suggesting osteopenia. Serum concentrations of calcium were significantly higher with VPA than in PHT or control groups. Serum concentrations of bone Gla protein (a bone formation marker) and pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a bone resorption marker) associated with either drug significantly exceeded control values. Z-scores for BMD in the VPA group correlated negatively with calcium and ICTP. High ICTP correlated positively with ionized calcium, implying that increased bone resorption caused the latter.

Conclusion:— Long-term VPA monotherapy can increase bone resorption, leading to decreased BMD.




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