Integrated Assessment of Bone Health in Adults with Epilepsy Receiving Antiseizure Medications in Basrah, Iraq

Mustafa  Abd Al Majeed; Ahmed Abduljawad Salim; Omar Mohammed Alsalman

doi:10.54133/ajms.v11i1.3046

Authors

Mustafa Abd Al Majeed Department of Physiology, College of Medicine, University of Basrah, Basrah, Iraq https://orcid.org/0000-0002-1459-9291
Ahmed Abduljawad Salim Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq https://orcid.org/0000-0003-0788-3144
Omar Mohammed Alsalman Department of Physiology, College of Medicine, University of Basrah, Basrah, Iraq https://orcid.org/0009-0003-5118-8912

DOI:

https://doi.org/10.54133/ajms.v11i1.3046

Keywords:

Antiseizure medications , Bone mineral density , Bone turnover markers , Calcitonin , DEXA, Epilepsy

Abstract

Background: Antiseizure medications (ASMs) are associated with skeletal complications, yet most studies rely on dual-energy X-ray absorptiometry (DEXA) alone. Combining DEXA with bone turnover markers (BTMs) and the mineral axis may improve identification of adults at risk for bone loss. Objective: To evaluate the diagnostic value of integrating DEXA with serum biomarkers in adults with epilepsy on chronic ASM therapy in Basrah. Methods: A cross-sectional comparative study enrolled 45 adults with epilepsy on ASMs for 12 months or longer and 45 age- and sex-matched healthy controls. Fasting morning blood samples were analyzed for the full biomarker panel. BMD was measured at the lumbar spine (L1–L4) and proximal femur by DEXA. An exploratory uncoupling index and turnover phenotypes were derived. Results: CTX-I and DPD were significantly higher in cases (p<0.001 and p=0.045). Calcitonin was elevated in cases (p<0.001) and positively correlated with ALP among cases only (rho=0.304, p=0.043). Mineral-axis markers did not differ between groups. The resorption-dominant phenotype was significantly more prevalent among cases (55.6% vs. 11.1%, p<0.001) and was associated with lower femur T-scores (p=0.007) and higher low-BMD prevalence (p=0.002). Conclusions: Integrating DEXA with CTX-I, DPD, and calcitonin reveals a high-resorption phenotype in ASM-treated adults that DEXA or mineral-axis testing alone would miss. This combined approach improves early identification of skeletal risk in epilepsy care.

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