According to a recent trial, vitamin D and calcium supplements improves bone mineral density in veterans with epilepsy.
November is National Epilepsy Awareness Month. Epilepsy is a common disorder that effects nearly 50 million people worldwide. Around 80% of people with epilepsy live in developing countries, and nearly 3 million Americans suffer from the disorder.
Epilepsy is characterized by recurrent seizures. It is important to note that one seizure doesn’t mean you have epilepsy, it is defined as two or more unprovoked seizures.
Patients with epilepsy are often prescribed continuous antiepileptic drugs (AEDs), to help control seizures. AEDs have been reported to accelerate bone loss, which increases risk of osteoporosis and subsequent fractures. People with epilepsy are already 2 to 6 times at greater risk from fractures, without factoring any bone loss. While researchers are still unclear on the exact increase in risk using AEDs, there is no doubt an increase.
In this recent study, researchers wanted to see if vitamin D and calcium supplements, along with risedronate, improves bone mineral density. Risedronate, a bisphosphonate, is a common drug prescribed to post-menopausal women and others to prevent and treat osteoporosis. There has been little research with vitamin D and epilepsy, and almost none have looked at its role in use of AEDs.
Thus, researchers conducted the first randomized controlled trial on patients taking AEDs. This antiepileptic drug and osteoporosis prevention trial (ADOPT) was a two year double blind clinical trial. They examined 80 male veterans, 53 of which completed the trial, all being treated with an AED for a minimum of two years.
Bone density assessments were conducted at baseline, one year into the study, and two years following enrollment. The participants were randomly split into two groups. Both groups received 500-750 IU of vitamin D and 1,000-1,500 mg of calcium supplements daily. Those who had vitamin D levels <20 ng/ml were given a loading dose of 50,000 IU weekly for 12 weeks prior to enrollment and being randomized into the study. One group additionally received the bisphosphonate risedronate while the other received a placebo.
Here’s what the research team found:
- Bone density at any of the tested sites improved in both groups, meaning that vitamin D and calcium supplementation were effective in increasing bone density. Sixty-nine percent of placebo group experienced improvement in bone density and 70% of the risedronate experienced bone density improvement.
- As to the efficacy of the risedronate, patients in the risedronate group showed statistically significant bone density increase in the lumbar spine compared to the placebo group.
- There were five new vertebral fractures in the placebo group compared to none in the risedronate group.
Dr. Lazzari, lead researcher in the trial, concluded,
“Our findings suggest calcium and vitamin D with or without risedronate improves bone density in epilepsy patients taking AEDs. Adding risedronate to the supplements appears to prevent new fractures in the group of veterans.”
The researchers were quick to note that anti-resorptive agents, such as risedronate, should only be used for a maximum of five years to reduce known side effects. The researchers call for future long-term studies of bisphosphonates for results and safety.
There is still much to be done with vitamin D and epilepsy. Vitamin D and calcium are known to work hand-in-hand to ensure strong, healthy bones throughout life. Keeping rapid bone loss in AED treatment in mind, it is critical for epileptic patients to be aware of their bone mineral density. This is especially true considering the general increased risk of falling that people with epilepsy have.
Furthermore, some longitudinal studies show vitamin D may help in epilepsy. One small study showed that improving vitamin D status may reduce number of seizures, although the study did not compare participants to a placebo group. If this is further corroborated with future research, vitamin D and calcium could be a driving force in improving overall quality of life for those with epilepsy.
Lazzari, AA., et. al. Prevention of bone loss and vertebral fractures in patients with chronic epilepsy-Antiepileptic drug and osteoporosis prevention trial. Epilepsia, 2013.