ANTICONVULSANT INDUCED METABOLIC DISORDER - CASE REPORT

Authors:

Dušanka Martinović Kaliterna, Zrinka Jurišić

Summary

Osteomalacia, metabolic bone disease in the adults, is disorder in which mineralization of the organic matrix of the skeleton is defective. This disorder is caused by a number of different conditions associated with alterations of vitamin D metabolism. Anticonvulsant therapy can also cause the development of osteomalacia due to alteration of vitamin D metabolism inducing hepatic mycrosomal enzymes, inhibiting 25-hydroxilation of vitamin D. They also inhibit intestinal calcium transport and bone mineral mobilization, independent of effects on vitamin D metabolism. This paper presents a patient who was unable to walk due to anticonvulsants induced osteomalacia. Anticonvulsant use has been implicated as a cause of bone disease for more than 30 years but there is no official recommendation for calcium and vitamin D therapy in anticonvulsant treated individuals.

Sažetak
Osteomalacija je metabolička bolest odraslih kod koje je poremećena mineralizacija organskog matriksa kosti. Vezana je uz različite poremećaje metabolizma vitamina D, a može se javiti i kod primjene antikonvulzivnih lijekova. Antikonvulzivi ubrzavaju katabolizam vitamina D induciranjem mikrosomskih enzima jetre, smanjuju bubrežnu hidroksilaciju vitamina D, imaju direktan učinak na gastrointestinalnu apsorpciju kalcija i s tim na remodelaciju kosti neovisnu o metabolizm  vitamina D. U radu je prikazana bolesnica u koje je dugotrajna politerapija antikonvulzivima prouzročila osteomalaciju i nepokretnost. Ova nuspojava poznata je u kliničkoj praksi više od trideset godine, ali nema jasnih smjernica za praćenje osteomalacije kao i za primjenu vitamina D i kalcija u bolesnika liječenih antikonvulzivnom terapijom.

Vol.: 55

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