Low bone mineral density associated with Carbamazepine use in adult patients with Epilepsy. Literature Review

Abstract

Introduction: Antiepileptic drugs (AEDs) are key to effectively control seizures in epilepsy. However, prolonged use, especially enzyme-inducing agents, significantly increases the risk of osteoporosis and fractures by reducing bone mineral density (BMD) and altering bone equilibrium. Carbamazepine is an established cause of secondary osteoporosis, typically manifesting in vertebral fractures. Objective: To thoroughly review existing scientific evidence on the potential impact of prolonged carbamazepine use on BMD of adult epilepsy patients, specifically to inform and improve clinical management strategies. Methodology: An exhaustive bibliographic review of 20 relevant scientific articles meticulously analyzing the relationship between AEDs and bone health was carefully conducted, including observational studies, rigorous systematic reviews, comprehensive meta-analyses, and insightful comparative studies. Results: The analyzed evidence consistently indicates that prolonged AED use, particularly enzyme-inducing agents such as carbamazepine, is strongly associated with a significant decrease in BMD and a higher risk of osteoporosis and fractures. Furthermore, this adverse effect directly relates to alterations in calcium and vitamin D metabolism. Carbamazepine has been linked to negative effects on bone health, with studies demonstrating lower levels of vitamin D and calcium. Conclusions: Scientific evidence is conclusive in identifying the use of carbamazepine as a significant and modifiable risk factor for the loss of BMD, osteoporosis, and fractures in adult patients with epilepsy. Therefore, it is crucial that health professionals are aware of this potential risk and proactively implement preventive strategies, such as routine BMD monitoring and adequate calcium and vitamin D supplementation.