抗癫痫药物与骨折风险_Journal of Epilepsy

Authors：

冉俊哲 ¹ ,  慕洁 ²

1. ;
2. ;

Corresponding author：

慕洁, Email: mujie2010@foxmail.com

Keywords：

抗癫痫药物; 骨折; 骨密度

DOI：

10.7507/2096-0247.20170062

Video：

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癫痫是神经系统的一种常见疾病，药物治疗是癫痫治疗的首选方法。由于癫痫病程长，患者常常需要长期服药甚至终身服药，药物长期服用的安全性是必须考虑的。有研究显示癫痫患者的骨折风险是普通人群的2~6倍，长期服用抗癫痫药物(AEDs)是导致骨折风险增加的独立危险因素。不同类型的AEDs对不同年龄阶段人群的骨代谢有不同的影响，应根据不同年龄选择合适的药物。如何预防骨折是癫痫专科医生应该关心的问题，应注意监测相关指标，防止骨折的发生。

Citation： 冉俊哲, 慕洁. 抗癫痫药物与骨折风险. Journal of Epilepsy, 2017, 3(5): 401-405. doi: 10.7507/2096-0247.20170062 Copy

1.	王文志, 吴建中, 戴秀英, 等.我国五省农村地区开展人群干预后癫痫治疗缺口的变化.中华神经科杂志, 2007, 40(6): 387-390.
2.	Pack AM. Treatment of epilepsy to optimize bone health.Curr Treat Options Neurol. 2011, 13(4): 346-354.
3.	Tsiropoulos I, Andersen M, Nymark T, et al. Exposure to antiepileptic drugs and the risk of hip fracture: a case-control study.Epilepsia, 2008, 49(12): 2092-2099.
4.	Shiek Ahmad B, Hill KD, O'Brien TJ, et al. Falls and fractures in patients chronically treated with antiepileptic drugs. Neurology, 2012, 79(2): 145-151.
5.	Kubota F, Kifune A, Shibata N, et al. Bone mineral density of epileptic patients on long-term antiepileptic drug therapy: a quantitative digital radiography study. Epilepsy Res, 1999, 33(2-3): 93-97.
6.	Zhang Y, Zheng Y, Zhu J, et al. Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: a meta-analysis. J Zhejiang Univ Sci B, 2015, 16(7): 611-621.
7.	El-Hajj Fuleihan G, Dib L, Yamout B, et al. Predictors of bone density in ambulatory patients on antiepileptic drugs. Bone, 2008, 43(1): 149-155.
8.	Lee HS, Wang SY, Salter DM, et al.The impact of the use of antiepileptic drugs on the growth of children. BMC Pediatr, 2013, 13: 211.
9.	van Staa TP, Leufkens HG, Cooper C. Utility of medical and drug history in fracture risk prediction among men and women. Bone, 2002, 31(4): 508-514.
10.	Shiek Ahmad B, Hill KD, O'Brien TJ, et al. Falls and fractures in patients chronically treated with antiepileptic drug. Neurology, 2012, 79(2): 145-151.
11.	Bjorholt PG, Nakken KO, Rohme K, et al. Leisure time habits and physical fitness in adults with epilepsy.Epilepsia, 1990, 31(1): 83-87.
12.	Petty SJ, Paton LM, O'Brien TJ, et al. Effect of antiepileptic medication on bone mineral measures. Neurology, 2005, 65(9): 1358-1365.
13.	Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc, 2002, 50(10): 1629-1637.
14.	Perucca E. Clinical implications of hepatic microsomal enzyme induction by antiepileptic drugs.PharmacolTher, 1987, 33(1): 139-144.
15.	段春波, 金世鑫.降钙素受体基因多态性与骨质疏松表型的研究进展.中国老年学杂志, 2005, 25(7): 867-869.
16.	许莉, 张金环, 许前.拉莫三嗪、卡马西平及丙戊酸对癫痫患儿的骨质影响.中国实用医药, 2011, 06(11): 166-167.
17.	吴丹红, 李承晏.抗癫痫药对癫痫患者骨代谢的影响.武汉大学学报(医学版), 2004, 25(3): 318-320.
18.	Nissen-Meyer LSH, Svalheim S, Tauboll E, et al. Levetiracetam, phenytoin, and valproate act differently on rat bone mass, structure, and metabolism. Epilepsia, 2007, 48(10): 1850-1860.
19.	Feldkamp J, Becker A, Witte OW, et al. Long-term anticonvulsant therapy leads to low bone mineral density-evidence for direct drug effects of phenytoin and carbamazepine on human osteoblast-like cells. Exp Clin Endocrinol Diabetes, 2000, 108(1): 37-43.
20.	鹿梁燕, 黄志凌.丙戊酸钠对成年癫痫患者骨代谢的影响.长治医学院学报, 2012, 26(04): 265-267.
21.	Gunes A, Bilir E, Zengil H, et al. Inhibitory effect of valproic acid on cytochrome P4502C9 activity in epilepsy patients. Basic Clin Pharmacol Toxicol, 2007, 100(6): 383-386.
22.	Humphrey EL, Morris GE, Fuller HR. Valproate reduces collagen and osteonectin in cultured bone cells. Epilepsy Res, 2013, 106(3): 446-450.
23.	Sheth RD, Hermann BP. Bone mineral density with lamotrigine monotherapy for epilepsy. Pediatr Neurol, 2007, 37(4): 250-254.
24.	Heo K, Rhee Y, Lee HW, et al. The effect of topiramate monotherapy on bone mineral density and markers of bone and mineral metabolism in premenopausal women with epilepsy.Epilepsia, 2011, 52(10): 1884-1889.
25.	Pack A. Levetiracetamtreatment does not result in broken bones. Epilepsy Curr, 2013, 13(2): 83-84.
26.	Andress DL, Ozuna J, Tirschwell D, et al. Antiepileptic drug-induced bone loss in young male patients who have seizures. Arch Neurol, 2002, 59(5): 781-786.
27.	Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system-active medications and risk for fractures in older women. Arch Intern Med, 2003, 163(8): 949-957.
28.	Ensrud KE, Walczak TS, Blackwell T, et al. Antiepileptic drug use increases rates of bone loss in older women: a prospective study. Neurology, 2004, 62(11): 2051-2057.
29.	Lambrinoudaki I, Kaparos G, Armeni E, et al. BsmI Vitamin D receptors polymorphism and bone mineral density in men and premenopausal women on long-term antiepileptic therapy. Eur J Neurol, 2010, 18(1): 93-98.

1. 王文志, 吴建中, 戴秀英, 等.我国五省农村地区开展人群干预后癫痫治疗缺口的变化.中华神经科杂志, 2007, 40(6): 387-390.
2. Pack AM. Treatment of epilepsy to optimize bone health.Curr Treat Options Neurol. 2011, 13(4): 346-354.
3. Tsiropoulos I, Andersen M, Nymark T, et al. Exposure to antiepileptic drugs and the risk of hip fracture: a case-control study.Epilepsia, 2008, 49(12): 2092-2099.
4. Shiek Ahmad B, Hill KD, O'Brien TJ, et al. Falls and fractures in patients chronically treated with antiepileptic drugs. Neurology, 2012, 79(2): 145-151.
5. Kubota F, Kifune A, Shibata N, et al. Bone mineral density of epileptic patients on long-term antiepileptic drug therapy: a quantitative digital radiography study. Epilepsy Res, 1999, 33(2-3): 93-97.
6. Zhang Y, Zheng Y, Zhu J, et al. Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: a meta-analysis. J Zhejiang Univ Sci B, 2015, 16(7): 611-621.
7. El-Hajj Fuleihan G, Dib L, Yamout B, et al. Predictors of bone density in ambulatory patients on antiepileptic drugs. Bone, 2008, 43(1): 149-155.
8. Lee HS, Wang SY, Salter DM, et al.The impact of the use of antiepileptic drugs on the growth of children. BMC Pediatr, 2013, 13: 211.
9. van Staa TP, Leufkens HG, Cooper C. Utility of medical and drug history in fracture risk prediction among men and women. Bone, 2002, 31(4): 508-514.
10. Shiek Ahmad B, Hill KD, O'Brien TJ, et al. Falls and fractures in patients chronically treated with antiepileptic drug. Neurology, 2012, 79(2): 145-151.
11. Bjorholt PG, Nakken KO, Rohme K, et al. Leisure time habits and physical fitness in adults with epilepsy.Epilepsia, 1990, 31(1): 83-87.
12. Petty SJ, Paton LM, O'Brien TJ, et al. Effect of antiepileptic medication on bone mineral measures. Neurology, 2005, 65(9): 1358-1365.
13. Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc, 2002, 50(10): 1629-1637.
14. Perucca E. Clinical implications of hepatic microsomal enzyme induction by antiepileptic drugs.PharmacolTher, 1987, 33(1): 139-144.
15. 段春波, 金世鑫.降钙素受体基因多态性与骨质疏松表型的研究进展.中国老年学杂志, 2005, 25(7): 867-869.
16. 许莉, 张金环, 许前.拉莫三嗪、卡马西平及丙戊酸对癫痫患儿的骨质影响.中国实用医药, 2011, 06(11): 166-167.
17. 吴丹红, 李承晏.抗癫痫药对癫痫患者骨代谢的影响.武汉大学学报(医学版), 2004, 25(3): 318-320.
18. Nissen-Meyer LSH, Svalheim S, Tauboll E, et al. Levetiracetam, phenytoin, and valproate act differently on rat bone mass, structure, and metabolism. Epilepsia, 2007, 48(10): 1850-1860.
19. Feldkamp J, Becker A, Witte OW, et al. Long-term anticonvulsant therapy leads to low bone mineral density-evidence for direct drug effects of phenytoin and carbamazepine on human osteoblast-like cells. Exp Clin Endocrinol Diabetes, 2000, 108(1): 37-43.
20. 鹿梁燕, 黄志凌.丙戊酸钠对成年癫痫患者骨代谢的影响.长治医学院学报, 2012, 26(04): 265-267.
21. Gunes A, Bilir E, Zengil H, et al. Inhibitory effect of valproic acid on cytochrome P4502C9 activity in epilepsy patients. Basic Clin Pharmacol Toxicol, 2007, 100(6): 383-386.
22. Humphrey EL, Morris GE, Fuller HR. Valproate reduces collagen and osteonectin in cultured bone cells. Epilepsy Res, 2013, 106(3): 446-450.
23. Sheth RD, Hermann BP. Bone mineral density with lamotrigine monotherapy for epilepsy. Pediatr Neurol, 2007, 37(4): 250-254.
24. Heo K, Rhee Y, Lee HW, et al. The effect of topiramate monotherapy on bone mineral density and markers of bone and mineral metabolism in premenopausal women with epilepsy.Epilepsia, 2011, 52(10): 1884-1889.
25. Pack A. Levetiracetamtreatment does not result in broken bones. Epilepsy Curr, 2013, 13(2): 83-84.
26. Andress DL, Ozuna J, Tirschwell D, et al. Antiepileptic drug-induced bone loss in young male patients who have seizures. Arch Neurol, 2002, 59(5): 781-786.
27. Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system-active medications and risk for fractures in older women. Arch Intern Med, 2003, 163(8): 949-957.
28. Ensrud KE, Walczak TS, Blackwell T, et al. Antiepileptic drug use increases rates of bone loss in older women: a prospective study. Neurology, 2004, 62(11): 2051-2057.
29. Lambrinoudaki I, Kaparos G, Armeni E, et al. BsmI Vitamin D receptors polymorphism and bone mineral density in men and premenopausal women on long-term antiepileptic therapy. Eur J Neurol, 2010, 18(1): 93-98.

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