Dados do Trabalho

Título

LOW BONE MINERAL DENSITY OCCURS IN MEN WITH EPILEPSY, REGARDLESS OF YOUNG AGE OR SURGICAL TREATMENT

Introdução

Although some studies showed increased risk of developing metabolic bone disease in people with epilepsy, little is known about the multifactorial underpinning mechanisms, especially in men. Aspects of bone metabolism such as vitamin D, calcium homeostasis and bone turnover markers may be negatively impacted by the use of antiseizure drugs (mainly the enzyme-inducers).

Objetivo

To evaluate the bone mineral density (BMD) in men with epilepsy and correlate it with clinical data such as age, type of seizure and anti-seizure drugs (ASD).

Método

We evaluated 505 men previously diagnosed with epilepsy and exposed (minimum of five years of exposure) to previous or current antiseizure drugs (phenobarbital, phenytoin, carbamazepine and valproic acid), followed at UNICAMP-Brazil in 2021. We identified 178 patients with BMD analysis (median age range, 50.5 (21-86 years). Individuals were split into two groups (young-group [21-49 years], 90 individuals; older group [50-86 years], 89 subjects). The BMD test evaluated t-score indexes from the femoral neck, whole femur and lumbar spine. Osteopenia was defined with a t-score of -1.0 to -2.4; osteoporosis, with T-scores lower than -2.5. Clinical data were extracted from medical records and analyzed with SPSS22. We performed chi-square tests for categorical variables.

Resultados

BMD was reduced in 107/179 men (59.7%). High-levels of bone disease were identified in both young and older patients (p=0.09): young-group [37/90 normal (41.1%), 40/90 osteopenia (44.4%), 13/90 osteoporosis (14.4%)]; older-group [35/89 normal (39.3%), 30/89 osteopenia (33.7%), 24/89 osteoporosis (26.9%)]. As expected, the osteoporosis group (20.6% of patients) was older than the osteopenia group (p=0.011). About 90% of patients with abnormal BMD had focal epilepsy. Unfortunately, 33/53 (62%) operated patients presented abnormal BMD.

Conclusões

We observed elevated levels of bone disease (regardless of the young age and surgical treatment) in men with epilepsy exposed to ASD. Our results suggest that ASD exposure is associated with early BMD reduction, which evolves into osteopenia and osteoporosis. BMD evaluation in patients with epilepsy and appropriate treatment may be necessary to reduce the risk of fractures and related comorbidities. The selection of appropriate ASD is of extreme importance to avoid bone disease in people with epilepsy, who usually require long-term treatment.