Comparison between the effects of older versus newer generations of antiepileptic drugs on bone metabolism in adult Iraqi patients: an observational study

Abstract

Background: Metabolic bone disorder is a significant endocrine system disorder that encompasses any disorder that alters the natural skeleton's mineralization process. Epilepsy is a prevalent central nervous system disorder that can cause biochemical abnormalities involving bone metabolism in the epileptic patients. The present study aimed to investigate the effects of chronic use of older compared to the newer generations of antiepileptic drugs on bone metabolism-related biomarkers. Methods: The study included fifty-one epileptic outpatients who attended the Consultation Clinic of Baghdad Teaching Hospital at the Medical City Complex from October/2021 to December/2021. The selected patients were on antiepileptic drugs for more than 2 years, hence were grouped according to their antiepileptic therapy into: Group-1: 24 epileptic patients on old antiepileptic drugs (Carbamazepine or Valproate). Group-2: 27 epileptic patients on new antiepileptic drugs (Levetiracetam), compared with Group-3: 28 healthy control subjects. Serum was obtained from their blood specimens to measure: calcium and inorganic phosphate by colorimetric assays, parathyroid hormone, and level of bone alkaline phosphatase activity. Results: Data analysis revealed that the median value of serum parathyroid hormone levels was significantly elevated in the epileptic patients' groups compared to the healthy control group. However, group-2 (new generation antiepileptic drugs) presented higher values. Whereas serum calcium and inorganic phosphate levels showed non-significant variation for all the studied groups. Furthermore, serum bone alkaline phosphatase activity exhibited significantly higher values in the patients compared to the healthy subjects group, with more significant elevation among those on old generation antiepileptic drugs (Carbamazepine or Valproate). Conclusion: Epileptic individuals who had been on AEDs for more than two years had increased parathyroid hormone levels, which were boosted by the newer antiepileptic drug Levetiracetam. Furthermore, BAP serum levels were considerably greater in epileptic patients than in healthy control participants, with larger values generated by older antiepileptic medications.