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Should children on prolonged antiepileptic drug therapy undergo DEXA scanning to assess bone mineral density?
  1. Milind Girish,
  2. Aman Mehan,
  3. Ashwin Venkatesh
  1. University of Cambridge School of Clinical Medicine, Cambridge, UK
  1. Correspondence to Milind Girish, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK; milindgirish{at}gmail.com

https://doi.org/10.1136/archdischild-2020-319695

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    Scenario

    A 9-year-old boy presents with a distal radial fracture following a fall from playground climbing equipment. Four years previously, subsequent to two episodes of generalised seizures, he was diagnosed with epilepsy and prescribed an ongoing long-term treatment of sodium valproate which has allowed effective seizure control. You have heard that antiepileptic medications have adverse effects on bone health, and wonder if he should have had bone mineral density (BMD) measurements to assess for that risk.

    This critically appraised topic therefore aims to assess whether the current evidence base is supportive of routine screening for low BMD after extended therapy and if so, after what duration.

    Structured clinical question

    Should children on prolonged antiepileptic drug therapy (population) undergo dual-energy X-ray absorptiometry (DEXA) scanning (intervention) to assess BMD (outcome)?

    Search

    Pubmed and Embase were searched in January 2020 with (epilepsy OR epileptic OR convulsive OR convulsant) AND (monitor OR screen OR surveillance OR DEXA OR Dual energy x-ray absorptiometry OR densitometry) AND (osteoporosis OR osteopenia OR osteopaenia OR bone mineral density OR fracture), yielding 334 studies and 314 studies, respectively. Cochrane library was searched with the search terms (epilepsy OR epileptic OR convulsive OR convulsant) AND (osteoporosis OR osteopenia OR osteopaenia OR bone mineral density OR fracture), yielding 72 studies. Within this search, 30 relevant studies were identified, 6 of which are included in this review (table 1).

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    Table 1

    Bone mineral density in epileptic children on AEDs

    Summary

    Commentary

    AED therapy has been correlated to reduced BMD within both adult1 and paediatric cohorts.2–8 …

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    Footnotes

    • Contributors AV, MG and AM contributed equally to the planning, conduct and reporting of the work described in the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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