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Journal of Zhejiang University SCIENCE B
ISSN 1673-1581(Print), 1862-1783(Online), Monthly
2015 Vol.16 No.7 P.611-621
Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: a meta-analysis
Abstract: Objective: The aim of our meta-analysis was to assess the effects of antiepileptic drugs on bone mineral density and bone metabolism in epileptic children. Methods: Searches of PubMed and Web of Science were undertaken to identify studies evaluating the association between antiepileptic drugs and bone mineral density and bone metabolism. Results: A total of 22 studies with 1492 subjects were included in our research. We identified: (1) a reduction in bone mineral density at lumbar spine (standardized mean difference (SMD)=−0.30, 95% confidence interval (CI) [−0.61, −0.05]), trochanter (mean difference (MD)=−0.07, 95% CI [−0.10, −0.05]), femoral neck (MD=−0.05, 95% CI [−0.09, −0.02]), and total body bone mineral density (MD=−0.33, 95% CI [−0.51, −0.15]); (2) a reduction in 25-hydroxyvitamin D (MD=−3.37, 95% CI [−5.94, −0.80]) and an increase in serum alkaline phosphatase (SMD=0.71, 95% CI [0.38, 1.05]); (3) no significant changes in serum parathyroid hormone, calcium, or phosphorus. Conclusions: Our meta-analysis suggests that treatment with antiepileptic drugs may be associated with decreased bone mineral density in epileptic children.
Key words: Antiepileptic drugs, Bone mineral density, Bone metabolism, Children, Meta-analysis
创新点:目前已有荟萃分析评估抗癫痫药对成人骨密度的影响,但尚无研究分析抗癫痫药对儿童的影响。
方法:检索PubMed和Web of Science数据库中评估抗癫痫药与儿童骨密度及骨代谢关系的临床试验。入选标准为:(1)至少包括一项骨代谢的标志物;(2)骨密度用双能×线吸收计量法计算;(3)研究结果包括平均的骨密度和骨密度的标准差;(4)年龄小于18岁;(5)患者采用单药或多药治疗;(6)具有健康对照组;(7)必须是观察性研究或随机对照研究。采用固定效应模型和随机效应模型对22篇文献的1492例患者中的骨密度及骨代谢资料进行荟萃分析,结果用加权均数差(WMD)或标准均数差(SMD)进行评估。
结论:共22篇文献符合纳入标准,共计1492例患者。荟萃分析的结果显示,抗癫痫药物的使用可以引起儿童:(1)腰椎、转子、股骨颈的骨密度和全身骨密度的下降;(2)维生素D下降和血清碱性磷酸酶的上升;(3)甲状旁腺激素、钙和磷没有显著改变。荟萃分析的结果表明,抗癫痫药的使用可能和癫痫病患儿骨密度降低相关。
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DOI:
10.1631/jzus.B1500021
CLC number:
R742.1
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On-line Access:
2024-08-27
Received:
2023-10-17
Revision Accepted:
2024-05-08
Crosschecked:
2015-06-16