Jump to content
CrazyBoards.org

drugs that have affect on bone integrity, osteoporosis,


Recommended Posts

topamax seems to help with neuropain. but at the same time it is a minor carbonic anhydrase inhibitor, so like diamox, it decreases increased intercranial pressure. but i feel like when i stop taking it, it has an affect on not just my bones, but my spine as well. while i was taking it i felt no ill effects, but when taking it, and combined with energy drinks, it seemed to have some sort of an affect on that area. as did trileptal to a greater extent.

i know not all anticonvulsants are the same but are topamax, trileptal, and tegretol the top of the list in terms of mood stabilizers that affect bone, joint function, as they are known to degrade bone, and demineralize bone structure more than others. (even lyrica and gabapentin to a lesser extent)

heck even PPI's, statins, and other drugs are being blamed for causing increased incidence of osteoporeosis.

Either I'm getting old or trileptal or topamax, definitely had an effect on my spine issues, specifically i feel that i get a pinch between my shoulder blades, almost like a pinched nerve, and i catn really fully exhale without some sort of crack in my back, or spinal cord.

which is why i take muscle relaxers and tylenol.

my question is, does depakote and drugs like lamictal also carry this risk ? to a greater or lesser extent?

Link to comment
Share on other sites

I've never heard about this from anyone but you. Given that your problems started after you'd stopped taking topamax, I have a hard time seeing how it could be responsible.

It sounds like you need to see a chiropractor.

Are you actually considering taking any specific med?

Link to comment
Share on other sites

true, you may not have heard of it from anyone but me.

but there were some very recent articles on psychotropic meds causing bone loss. specifically the anticonvulsants and antipsychotics. i believe i had read it somewhere in september or october of 2010 through medscape.

there were a few references in crazymeds home website, where they write up on the meds,

Link to comment
Share on other sites

Either I'm getting old or trileptal or topamax, definitely had an effect on my spine issues, specifically i feel that i get a pinch between my shoulder blades, almost like a pinched nerve, and i catn really fully exhale without some sort of crack in my back, or spinal cord.

which is why i take muscle relaxers and tylenol.

Are you seeing an orthopedic specialist? If I had stuff like this going on with my back, I'd go see a doctor. If you can't exhale without feeling a crack in your back, something is happening. I don't think taking muscle relaxers and Tylenol is necessarily the best approach, unless they have been prescribed by your doctor.

olga

Link to comment
Share on other sites

http://www.medscape.com/viewarticle/722600

http://www.medscape....warticle/721583

believe me i've been dealing with this for awhile, and all the doctors say it is mainly in my mind for the most part.

well first i went to a neurologist, and he suggested i had myasthenia gravis, which is a progressive weakening of muscles, respiratory muscles or muscles around the neck in particular. he ran a few electroshock tests, to measure the muscle response and concluded I had a probably case of myasthenia gravis and put me on mestinon and said, if these work then you could have myasthenia gravis, they helped a few days, but then i started having eye twitching and progressive muscle weakness instead of strengthening.

he also set up a muscle biopsy to further check, but i cancelled that cause i didnt believe i had myasthenia gravis. as im so young, 26 male.

and after that my primary care told me i needed to have my stomach checked out(endoscope), and a chest xray and also a chest ctscan.

everything came back fine, or negative for any problems, except for inflammation in my esophagus. whcih they said was due to GERD, and told me to take PPIs which have never agreed nor helped my issue, even after taking them for a month.

Link to comment
Share on other sites

For those who can't get the first article, a little excerpt.

Many Psychotropic Medications May Be Bad for Bones

Caroline Helwick

Mental Disorders Also Have an Impact

Mental disorders themselves also had statistically significant osteoporotic effects, he added. Odds ratios were 1.34 for dementia (95% CI, 1.04 – 1.72), 1.92 for schizophrenia (95% CI, 1.11 – 3.33), and 1.53 for alcohol dependence (95% CI, 1.01 – 2.32), whereas risk was reduced, interestingly, with depression, which carried an odds ratio of 0.85 (95% CI, 0.75 – 0.95). Bipolar disorder and drug abuse or dependence was not significantly associated with osteoporosis.

"SSRIs, anticonvulsant mood stabilizers, and benzodiazepines are associated with osteoporotic changes in bone, independent of the effects of mental disorders and other confounders, and tricyclic antidepressants appear to be protective," Dr. Bolton concluded.

He acknowledged that the investigators were not able to assess medication compliance, use of supplements (vitamin D, calcium), and lifestyle risk factors or interventions.

"There are clinical implications in that physicians may choose tricyclic antidepressants ahead of SSRIs for treating depression in patients deemed at risk of osteoporosis," he suggested.

"Similarly, lithium may be a preferred option in bipolar disorder patients at risk, while anticonvulsants may be better suited as second-line options. But most importantly, psychiatrists should maintain an awareness that many of their patients are at risk for osteoporosis and should investigate and manage this appropriately."

Link to comment
Share on other sites

I think that many, if not most, of us acknowledge the ever-present risks of osteoporosis. I failed to find mention of spinal stenosis resulting from anticonvulsants, et al in this link, or did I simply overlook the reference?

Her project systematically examined osteoporosis risk factors via personalized screening to determine whether osteoporosis prevention is warranted in midlife mood-disordered patients. The 19 patients (mean age, 47 years; 94% female) were recruited from a university psychiatric partial hospitalization program and an urban university neighborhood family medical center.

Again, I do not see mention of spinal stenosis in this discussion of fractures in post-menopausal women concurrently treated with PPI

"With a sample of 130,487 postmenopausal women and extensive follow-up (7.8 years), they [Gray et al.] found that PPIs were associated with an increased rate of spine, lower arm, and total fractures," Dr. Katz writes. "The increases in risk were modest (eg, the hazard ratio for total fractures was 1.25 [95% CI, 1.15-1.36]), but increases of common conditions due to commonly used medications add up to a lot of morbidity on a population level."

I am currently undergoing therapy with some drugs that come with a black box warning about the risks of bone loss, osteoporosis, and fractures on the long bones, but find no evidence of a warning for spinal stenosis for them either.

Link to comment
Share on other sites

Not to mention, post-menopausal women are often osteopenic, or have osteoporosis to start with. The drugs may also have an effect. But if the subjects were already on these medications when the tests were done, how were they able to discern how much of the bone damage is due to a very common problem in aging women, and how much is medication related?

Link to comment
Share on other sites

I think that many, if not most, of us acknowledge the ever-present risks of osteoporosis. I failed to find mention of spinal stenosis resulting from anticonvulsants, et al in this link, or did I simply overlook the reference?

True, yeah i threw in spinal stenosis mistakenly, for lack of a better word, or i just used it incorrectly ill fix that.

and why would i take muscle relaxers without a real script for it? I mean it's not like I'm out there buying "methocarbomol from the internet" and using that. as i've seen ome people on this forum do. methocarbomol is not even a legal OTC muscle relaxer in the states. and there is no correlate between use of muscle relaxers and the symptoms i was having with my breathing.

Link to comment
Share on other sites

Ya' know, the risk of dying from multiple causes of MI while untreated is a helluva lot higher than the POSSIBLE minor risk of increased chance of osteoporosis!

I think this is one of those cases where reading too much of the PI sheets can be a bad thing. ;)

Take your meds, have a cheese sandwich with a big glass of milk, then go hit the gym for weight lifting!

a.m.

Link to comment
Share on other sites

A bit weird to see this topic, as I've recently been diagnosed with osteopenia (precursor to osteoporosis), and was told by my orthopaedic surgeon yesterday that AC meds are a contributing factor to this. The results of my bone density scan were pretty damning, and apparently I'm prone to fractures (currently dealing with a foot injury) to an extent that I shouldn't be at my age (late 30's). Osteoporosis runs rampant in the women in my family, so I'm pretty much doomed from that point of view, but I had no idea that the meds might play a role too. I've done no independent research into this, so can't comment further as yet.

Link to comment
Share on other sites

he also set up a muscle biopsy to further check, but i cancelled that cause i didnt believe i had myasthenia gravis. as im so young, 26 male.

A female friend of mine was diagnosed at 22, and it had progressed far enough before treatment that she could barely walk due to tripping/fatigue.

A lot of things are not picky with regards to your age.

Link to comment
Share on other sites

Ya' know, the risk of dying from multiple causes of MI while untreated is a helluva lot higher than the POSSIBLE minor risk of increased chance of osteoporosis!

I think this is one of those cases where reading too much of the PI sheets can be a bad thing. ;)

Take your meds, have a cheese sandwich with a big glass of milk, then go hit the gym for weight lifting!

a.m.

hahah love this! i wish there was something like a thank you, or "like" akin to facebook.

Link to comment
Share on other sites

True, yeah i threw in spinal stenosis mistakenly, for lack of a better word, or i just used it incorrectly ill fix that.

Mistakenly...just throwing something out there is a dangerous thing to do when you are dealing with crazy folks. Please be more aware, more careful, and more accurate when throwing things in.

Link to comment
Share on other sites

Ya' know, the risk of dying from multiple causes of MI while untreated is a helluva lot higher than the POSSIBLE minor risk of increased chance of osteoporosis!

I think this is one of those cases where reading too much of the PI sheets can be a bad thing. ;)

Take your meds, have a cheese sandwich with a big glass of milk, then go hit the gym for weight lifting!

a.m.

I actually disagree with you on this one. It is important information if a person has significant osteoporosis in their family. It is important for menopausal women. The knowledge for some would translate into vitamin D tests and a greater focus on activities that can stave it off. Also, one can work with their doc on a more AAP focused med regimen. Knowledge is power and this particular issue is significant for some. Of course, I am biased. I now have osteopenia whereas a few years ago I was fine.

Link to comment
Share on other sites

I actually disagree with you on this one. It is important information if a person has significant osteoporosis in their family. It is important for menopausal women. The knowledge for some would translate into vitamin D tests and a greater focus on activities that can stave it off. Also, one can work with their doc on a more AAP focused med regimen. Knowledge is power and this particular issue is significant for some. Of course, I am biased. I now have osteopenia whereas a few years ago I was fine.

!

Yes and you are in a different situation and category. I wouldn't give you the same advice! :)

a.m.

Link to comment
Share on other sites

There are numerous citations in recent publications. I chose the two most recent literature reviews and edited them for succintnss. One thing to keep in mind is that Epilepsy patients probably tend to take much higher dosages of AC's, and often several types. They may be more prone to bone loss than a typical MI patient. r

Also note that it appears the worst agents are the older 'enzyme inducing' AC's. Certainly on should talk with ALL your doctors before changing meds. a.m.

Nakken KO, Taubøll E. Expert Opin Drug Saf. 2010 Jul;9(4):561-71.

ISSUES: Enzyme-inducing drugs, such as phenytoin, phenobarbital and carbamazepine, but also the enzyme inhibitor valproate, appear to have bone-depleting properties. Reduced bone density may be detected during the first 1 - 5 years of treatment. Although many theories have been launched, the exact mechanisms by which the the drugs affect bone architecture are not fully understood.

TAKE HOME MESSAGE: We recommend clinicians to promote osteoprotective behavior among their epilepsy patients; that is, sunlight exposure and weight-bearing exercise as well as avoidance of risk factors such as bone-depleting drugs other than AEDs, smoking and heavy alcohol consumption. Enzyme inducing drugs should be avoided, if possible. Bone mineral density screening should be assessed on an individual basis, taking risk factors for bone loss into account. All patients taking AEDs on long-term basis ought to have adequate amounts of dietary calcium and vitamin D, and those who have developed bone loss should in addition be given specific antiosteoporotic treatment.

http://www.ncbi.nlm.nih.gov/pubmed/20201711/

Am J Geriatr Pharmacother. 2010 Feb;8(1):34-46.

A review of the effect of anticonvulsant medications on bone mineral density and fracture risk.

Lee RH, Lyles KW, Colón-Emeric C.

CAUSE: Hepatic enzyme induction by certain anticonvulsant medications appears to contribute to increased metabolism of 25-hydroxyvitamin D to inactive metabolites, which results in metabolic bone disease. There is increasing evidence that anticonvulsant use is associated with a higher risk of osteoporosis and clinical fractures, especially among older agents such as phenobarbital, carbamazepine, phenytoin, and valproate. Several observational studies suggest a class effect among anticonvulsant agents, associated with clinically significant reductions in bone mineral density and fracture risk.

RISK: The use of anticonvulsant medications increases the odds of fracture by 1.2 to 2.4 times. However, only 2 large-scale observational studies have specifically examined the risk among those aged >65 years.

Vitamin D: This review also identified a randomized controlled trial whose results suggest that supplementation with high-dose vitamin D may be associated with increased bone mineral density in patients taking anticonvulsant medications.

No Present Guidelines: However, no randomized controlled trials investigating therapeutic agents to prevent fracture in this population were identified. Consequently, there are no formal practice guidelines for the monitoring, prevention, and management of bone disease among those taking anticonvulsants. http://www.ncbi.nlm.nih.gov/pubmed/20226391

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...