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抗癲癇藥物對骨骼健康的影響 Impact of antiepileptic drugs on bone health, ADEs, 病理機轉,…

- - - - due to reduction of BMD
      - children & adults with epilepsy have risk of Fr 2~6 times than the general population
      - Balance impairment
        
        significantly mean with-pair difference in test of static & dynamic balance
      - fall due to seizure
        
        tonic-clonic seizure
    - - postmenopausal women Tx with Phenytoin,BMD reduced both at hip & calcaneous. Pre-menopausla women Tx with Phenytoin,BMD reduced at the femoral neck of the hip.
      - many factors associated with decreased BMD: decreased physical activity, inadequate calcium &protein intake, poorer general health, and depression
      - gender difference
      - AEDS difference
    - - disorder of increased remodeling rather than abnormal mineralization
        
        osteomalacia
        
        Osteoporosis
    - - elevated alkaline phosphatase
      - low 25(OH)D
      - C-terminal telopeptide(CTx)
      - human type I collagen
      - Hypocalcemia
      - cross-linked N-telopeptides of type 1 collage ( NTx)
- - - - Decreased serum calcium
        concentaration
        
        Compensatory increase in PTH levels
        
        Increased bone resorption
        
        Reduction in BMD
        
        Osteoporosis
        
        Increased
        fracture risk
    - - Rickets in
        children
      - Osteomalacia
        in adults
- - - - selective estrogen receptor modulators
      - PTH
      - bisphosphonates
      - Vitamin D
        
        Low dose 400 IU/day for adults & children
        
        high dose 4000 IU/day for adults , 2000IU /day for children
      - calcium supplement