Wednesday, April 6, 2011

Bone health and anti-epileptic medicine: Those taking anti-epileptic drugs should drink lot of milk to prevent bone fracture

Syed Akbar
Hyderabad: Those on anti-epileptic drugs should drink lot of milk to keep their bones healthy, as there's a two to six times increased risk for fracture in people with epilepsy than in the general population.

A team of researchers from Sri Venkateswara Institute of Medical Sciences, Tirupati, has found that people on anti-epileptic drugs show low calcium and vitamin D content in their body and are thus exposed to the risk of fracture. Those on anti-epileptic drugs should include calcium and vitamin D rich diet to reduce the risk.

"There is a two to six times increased risk for fracture in people with epilepsy. The risk of fracture could be definitely more in patients with weak bones. There is mounting evidence of anti-epileptic drug induced bone changes, particularly with medicines like carbamazepine, phenytoin,  phenobarbitone and valproate. Low dietary calcium further accelerates the parathyroid response to vitamin D insufficiency," the researchers pointed out in the study.

The SVIMS team, comprising Dr B Mohan, Dr CV Harinarayan, Dr MN Raj, Dr TK Afsana, Dr Vemuri Swapna, and Dr G Hima Bindu, studied about 350 people with epilepsy and found that low dietary calcium could have a confounding effect on patients in all age groups.

"Our study showed that the diet of all patients with epilepsy was deficient in total calories and calcium. This was so across all the socio-economic groups. The diet of children and adolescent was far below the recommended daily dietary allowance of calcium of 400 mg in adult men, women and 1,000 mg pregnant and lactating women by the Indian Council of Medical Research,"
the researchers pointed out.

Low dietary calcium leads to decreased plasma calcium which triggers secondary hyperparathyroidism (over activity of parathyroid glands) leading to osteoclast (bone cells) activity and calcium release from bone. With ageing, there is reduced intestinal calcium absorption, increased bone resorption than formation. The study showed that women aged between 15-45 years were grossly deficient in their dietary calcium intake.

"In a setting where the diet of the population is already low in calcium, the effect of anti-epileptic drug can further accelerate the bone loss. Moreover, in the present study, only 42 per cent of the patients consumed milk and milk products which is the principal source of dietary calcium. Non dairy sources of food cannot meet the requirement of calcium," they added.

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