The effects of valproic acid (VPA) and carbamazepine (CBZ) on bone mineral density were evaluated in 53 children with primary epilepsy treated for longer than 1 year at the Gulhane Military Academy, Ankara, Turkey. Mean serum levels of VPA and CBZ were 66 and 7 mcg/ml, respectively. Serum levels of calcium and phosphorus were normal. Mineral densities measured by x-ray absorptiometry at L2-L4 were not significantly different from a control group. [1]

COMMENT. Previous studies have referred to the occurrence of rickets in children taking antiepileptic drugs. A decrease in serum calcium and elevations in alkaline phosphatase (ALP) have been reported, and nonambulatory, handicapped children are at greater risk of rickets. Elevated ALP values, observed in 16% of the VPA and 21% of CBZ-treated patients, point to an increased risk of rickets and bone fractures in some children. The importance of monitoring calcium intake and bone metabolism of women with epilepsy is stressed in the following articles.