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J R Soc Med. 1987 July; 80(7): 425–427.
PMCID: PMC1290903

Anticonvulsant drugs and bone disease in the elderly.


Elderly psychiatric inpatients were studied to find the prevalence of osteomalacia in those taking anticonvulsant medication (n = 19) and a comparison group not taking these drugs (n = 37). Only one biopsy-proven case was discovered among the anticonvulsant group, and none in the comparison group. This was an unexpectedly low rate. The clinical and biochemical data (including alkaline and acid phosphatase isoenzymes) were further analysed to detect subclinical osteomalacia, but none was found. A difference between the two subgroups was found for total and liver alkaline phosphatase only. The possible explanations for these unexpected findings are discussed. The effect of anticonvulsants on vitamin D and bone metabolism is reviewed and the hypothesis that drug-induced changes in vitamin D metabolism are responsible for the bone changes described in earlier series is questioned.

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Selected References

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  • Dent CE, Richens A, Rowe DJ, Stamp TC. Osteomalacia with long-term anticonvulsant therapy in epilepsy. Br Med J. 1970 Oct 10;4(5727):69–72. [PMC free article] [PubMed]
  • Hodkinson HM, Round P, Stanton BR, Morgan C. Sunlight, vitamin D, and osteomalacia in the elderly. Lancet. 1973 Apr 28;1(7809):910–912. [PubMed]
  • Soutoul JH, Tichet J, Renaud M, Welfens-Ekkra C, Vol S, Boulard P, Cochereau JM, Peru D, Tiercelin D. Contraception orale dans la Région Centre. Variation de profil d'âge et de profession à propos de 21 000 dossiers en 5 ans (1973-1977). J Gynecol Obstet Biol Reprod (Paris) 1979 Apr-May;8(3):193–199. [PubMed]
  • Corless D, Boucher BJ, Cohen RD, Beer M, Gupta SP. Vitamin-D status in long-stay geriatric patients. Lancet. 1975 Jun 28;1(7922):1404–1406. [PubMed]
  • Corless D, Gupta SP, Switala S, Barragry JM, Boucher BJ, Cohen RD, Diffey BL. Response of plasma-25-hydroxyvitamin D to ultraviolet irradiation in long-stay geriatric patients. Lancet. 1978 Sep 23;2(8091):649–651. [PubMed]
  • Adams JS, Clemens TL, Parrish JA, Holick MF. Vitamin-D synthesis and metabolism after ultraviolet irradiation of normal and vitamin-D-deficient subjects. N Engl J Med. 1982 Mar 25;306(12):722–725. [PubMed]
  • Corless D, Dawson E, Fraser F, Ellis M, Evans SJ, Perry JD, Reisner C, Silver CP, Beer M, Boucher BJ, et al. Do vitamin D supplements improve the physical capabilities of elderly hospital patients? Age Ageing. 1985 Mar;14(2):76–84. [PubMed]
  • McMartin DN, O'Connor JA, Jr, Fasco MJ, Kaminsky LS. Influence of aging and induction of rat liver and kidney microsomal mixed function oxidase systems. Toxicol Appl Pharmacol. 1980 Jul;54(3):411–419. [PubMed]
  • Trembath PW, Thorsborne-Palmer DD, Jarrott B, Hammond JJ, Prinsley DM. Theophylline pharmacokinetics in patients from a geriatric hospital: influence of cigarette smoking. Hum Toxicol. 1986 Jul;5(4):265–268. [PubMed]
  • Jubiz W, Haussler MR, McCain TA, Tolman KG. Plasma 1,25-dihydroxyvitamin D levels in patients receiving anticonvulsant drugs. J Clin Endocrinol Metab. 1977 Apr;44(4):617–621. [PubMed]
  • Bell RD, Pak CY, Zerwekh J, Barilla DE, Vasko M. Effect of phenytoin on bone and vitamin D metabolism. Ann Neurol. 1979 Apr;5(4):374–378. [PubMed]
  • Kafetz K, Hodkinson HM. Osteomalacia in presence of "normal" serum 25-hydroxycholecalciferol concentration. Br Med J (Clin Res Ed) 1981 Nov 28;283(6304):1437–1437. [PMC free article] [PubMed]
  • Bouillon R, Reynaert J, Claes JH, Lissens W, De Moor P. The effect of anticonvulsant therapy on serum levels of 25-hydroxy-vitamin D, calcium, and parathyroid hormone. J Clin Endocrinol Metab. 1975 Dec;41(06):1130–1135. [PubMed]
  • Rodbro P, Christiansen C, Lund M. Development of anticonvulsant osteomalacia in epileptic patients on phenytoin treatment. Acta Neurol Scand. 1974;50(4):527–532. [PubMed]
  • Christiansen C, Rodbro P, Lund M. Incidence of anticonvulsant osteomalacia and effect of vitamin D: controlled therapeutic trial. Br Med J. 1973 Dec 22;4(5894):695–701. [PMC free article] [PubMed]
  • Lidgren L, Nilsson BE, Wallöe A. Bone mineral content in epileptics. Calcif Tissue Int. 1979 Oct 31;28(2):99–102. [PubMed]
  • Jenkins MV, Harris M, Wills MR. The effect of phenytoin on parathyroid extract and 25-hydroxycholecalciferol-induced bone resorption: adenosine 3, 5 cyclic monophosphate production. Calcif Tissue Res. 1974;16(2):163–167. [PubMed]

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