- A Case of Osteomalacia with Multiple Fractures and Hypocalcemia Associated with Phenytoin Therapy.
-
Eun Kyung Kim, Min Suk Lee, Yoon Sok Chung, Kyu Sung Kwack, Ji Man Hong, Ye Yeon Won
-
J Korean Endocr Soc. 2009;24(3):212-216. Published online September 1, 2009
-
DOI: https://doi.org/10.3803/jkes.2009.24.3.212
-
-
 Abstract
 PDF
- Many studies have shown that patients taking antiepileptic drugs are at an increased risk for metabolic bone disease and low bone mineral density. Traditionally, this has been attributed to alterations in vitamin D metabolism by antiepileptic drugs which induce hepatic microsomal cytochrome P450 enzyme. However, there appear to be multiple mechanisms for antiepileptic drug-induced bone loss including lack of physical activity, reduced sunlight exposure, increased propensity for falling, and fractures associated with seizures or loss of consciousness. We experienced a case of antiepileptic drug-induced osteomalacia in a 63-year-old woman who had been on phenytoin for 8 years and was admitted with hypocalcemic seizures and multiple pathological fractures. This patient also had other risk factors for osteomalacia including reduced sunlight exposure, prolonged immobilization, and decreased dietary vitamin D intake. We discontinued phenytoin, and started calcium and vitamin D replacement. The patient's serum calcium and vitamin D level were normalized after treatment. Metabolic bone disease including osteomalacia should be considered in patients who are taking antiepileptic drugs especially those who are exposed to other risk factors.
- Effect of Sequential Therapy with Incadronate after Withdrawal of Recombinant Human Parathyroid Hormone(1-84) on Bone Quantity and Quality in Ovariectomized Rats.
-
Yumie Rhee, Jong Chan Youn, Ye Yeon Won, Myong Hyun Baek, Sung Kil Lim
-
J Korean Endocr Soc. 2005;20(4):334-343. Published online August 1, 2005
-
DOI: https://doi.org/10.3803/jkes.2005.20.4.334
-
-
Abstract
PDF
- BACKGROUND
Human parathyroid hormone(hPTH) is a promising anabolic agent. However, since hPTH (1-34) is available only via injection, and has a critical side effect of causing bone tumors during life-long administration in the rat, it would be practical to use PTH for the shortest possible duration to obtain the maximal effect. In addition, acquired bone mass due to hPTH tend to decrease after drug cessation. To determine the effectiveness of the osteoporosis-reversing concept of lose, restore, and maintain(LRM), recombinant human PTH(1-84)[rhPTH(1-84)] and the respective anti-resorptive agents were sequentially studied. METHODS: Thirty six, 20-week-old, Sprague-Dawley rats were used in this study. Treatment was started on the 25th week after an ovariectomy, which had been performed at 20weeks of age, with 5weeks of rhPTH (1-84) 100(microgram/kg/d), 5days/wk, followed by the respective sequential therapies for 5 weeks as follows: 1) Ovariectomized rats(OVX, n=6), 2) Sham operated rats(SHAM, n=6), 3) OVX rats with PTH maintenance(PTH-M, n=6), 4) OVX rats treated with PTH then withdrawn(PTH-W, n=6), 5) PTH-treated OVX rats then treated with 17beta-estradiol(PTH-E, 10microgram/d, SQ, 5days/wk, n=6), 6) PTH-treated OVX rats then treated with incadronate(PTH-I, 3mg/kg, per os 5 days/wk, n=6). The bone mineral density(BMD) of the right femurs was measured using dual X-ray absorptiometry(DXA). Microcomputed tomography(microCT) was used to measure the structural parameters of the 2nd lumbar vertebrae. A three-point bending test of the femur and compressive tests of vertebrae were also performed. RESULTS: Bone quantity data showed that the femoral BMD was significantly higher in the PTH-M and PTH-I groups than in the OVX and PTH-W groups(P<0.05). Measurement of the cortical thickness revealed that only the PTH-M group had a significant increase(P=0.001). The ultimate force(Fu) at the midshaft of the femur was stronger in the PTH-M group than in the OVX group(P<0.001). However, no significant difference was found among the treated groups. CONCLUSION: PTH withdrawal resulted in the loss of the acquired BMD, but sequential therapy with the anti-resorptive, incadronate, prevented further bone loss. The use of incadronate after rhPTH(1-84), as a sequential regimen, was significantly effective on the maintenance in the bone mass, but further clarification in the improvement in the bone quality is needed.
|
KES
