Bone health and vitamin D status in young epilepsy patients on valproate monotherapy

• Many anti-epileptic drugs are associated with impaired bone metabolism.
• We recorded lower bone mineral density measurements in young epilepsy patients on valproate monotherapy compared to controls.
• Highly prevalence of hypovitaminosis D in both epileptic and control groups was observed.

ObjectiveTo evaluate bone health and vitamin D adequacy in a cohort of epilepsy patients on chronic valproate (VPA) monotherapy.MethodsBone mineral density (BMD) using dual X-ray absorptiometry and serum concentrations of 25-hydroxyvitamin D, parathyroid hormone, calcium, phosphorus, and alkaline phosphatase were measured in 50 young adult epilepsy patients on VPA monotherapy and 50 age, sex and socioeconomically matched healthy subjects.ResultsMean age of epilepsy patients was 26 ± 7.2 (±SD) years, and females constituted 66%. Significantly lower mean lumbar spine and femoral neck BMDs (g/cm2) and lower femoral neck Z-score were observed in epilepsy patients in comparison with controls. Prevalence of low BMD (Z-score ≤−2.0) was 26% and 10% at lumbar spine, and 10% and 4% at femoral neck in epileptic and control groups respectively. No correlation was found between duration or dosage of VPA and BMDs. Vitamin D deficiency (≤20 ng/ml) was highly prevalent (>90%) in epilepsy patients and controls.ConclusionChronic VPA therapy is associated with lower BMD measurements in young epilepsy patients. Hypovitaminosis D is highly prevalent in general population.Practice implicationsProphylactic and therapeutic strategies against osteoporosis should be implemented in VPA-treated patients. Routine evaluation for bone disease by measuring BMD and supplementation of calcium and vitamin D can allow effective treatment of epilepsy without bone adverse effects.