Uzun süreli antiepileptik ilaç tedavisine bağlı osteomalazi

Year 2005, Volume: 12 Issue: 2, 34 - 37, 08.04.2009

Vedat Yürekli Selami Akkuş Galip Akhan M.Numan Tamer Zafer Yönden

Abstract

SüleymanDemirel Üniversitesi
TIP FAKÜLTESİ DERGİSİ: 2005 Haziran; 12(2)








Uzun süreli antiepileptik ilaç tedavisine bağlı osteomalazi



Vedat Yürekli, Selami Akkuş , Galip Akhan, M. Numan Tamer, Zafer Yönden





Özet

Osteomalazi önlenebilir ve tedavi edilebilir bir hastalıktır. Bir çok immobil ve yaşlı hasta güneş ışığına seyrek olarak çıkmaları nedeniyle osteomalazi gelişmesi yönünden risk altındadırlar. Diyetle yetersiz alım, malabsorbsiyon, karaciğerde vitamin D'nin zayıf hidroksilasyonu ve yetersiz renal fonksiyonlar diğer faktörlerdir. Başka bir predispozan faktörse uzun süreli antikonvulzan kullanımıdır. 25-hidroksikolekalsiferol seviyelerinin ölçülmesi vitamin D eksikliğini saptamada en iyi belirleyicidir. Uzun süreli antiepileptik kullanımının kemik metabolizması üzerine etkisini araştırmak üzere osteomalazi semptom ve bulgusu olmayan 50 epileptik hasta ve 15 sağlıklı kontrol çalışmaya dahil edildi. Kontrol grubu ile karşılaştırıldığında hasta grubunda anlamlı olarak serum alkalen fosfataz düzeyleri yüksek (p=0,001) ve serum 25(OH) D düzeyleri düşük (p=0,000) bulundu. Bulgularımız yeterli diyet ve güneş ışığı alan ambulatuvar epileptik hastalarda klinik olarak belirti ve bulgu vermeyen kemik metabolizması bozukluğunun (osteomalazi) görülebileceğini göstermektedir. Sonuç olarak epileptik hastalar antikonvulzanlara bağlı osteomalazi yönünden taranmalı ve vitamin D ile proflaktik olarak tedavi edilmeleri de uygun olabilir.



Anahtar kelimeler: Epilepsi, Antiepileptik ilaç, Osteomalazi, 25(OH) vitamin D.



Abstract



Osteomalacia Due to Long-term Treatment With Antiepileptic Drugs

Osteomalacia is a preventable and treatable disease. Many immobil and elderly patients are at risk of developing osteomalacia as they rarely go out in the sun. A poor diet, malabsorbsiyon, poor hydroxylation of vitamin D in the liver and poor renal function are other contributory factors. Another predisposing association is long term anticonvulsant therapy. The measurement of 25-hydroxycholecalciferol levels is considered to be the best indicator of the vitamin-D status. To investigate of chronic antiepileptic treatment on the bone metabolism 50 adult epileptics and 15 healthy controls were enrolled in the study. None of the patients had symptoms or signs suggestive of osteomalacia. Serum alkaline phosphatase levels were significantly increased (p=0,001) and serum 25(OH) vitamin D levels were significantly decreased (p=0,000) in the patients compared with controls. Our findings indicate that though the ambulatory epileptic patients with adequate diet and sunlight exposure clinically irrelevant impairment of bone metabolism (osteomalacia) might seen. It has been suggested that epileptic patients should be screned for anticonvulsant osteomalacia and possibly should receive prophylactic treatment with vitamin D.



Key words: Epilepsy, Antiepileptic drugs, Osteomalacia, 25(OH) vitamin D.

Keywords

Epilepsi, Antiepileptik ilaç, Osteomalazi, 25(OH) vitamin D

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