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Vitamins
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
There is some decrease in the bone mineral content, which is most marked in patients on high doses of multiple AEDs (15,22–24). The incidence ranges from 10 to 50% of patients surveyed. Bone demineralization can be shown by x-ray or by gamma ray densitometry, or by photon absorptometry. Decreased mineral content can become evident after several months of drug therapy. The severity, at least in part, is related to both the total drug dosages and to the duration of therapy. It is particularly accentuated in areas of the world where there is less sunlight and institutionalized patients with less physical activity and less vitamin D in the daily diet (23,26). If severe, the demineralization can lead to pathologic fractures; this is uncommon, however, in the average epileptic population (26).
Homocystinuria
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Ancillary supportive measures may be necessary. Orthopedic intervention may be required for pes planus and lower extremity valgus. The utility of agents such as bisphosphonates to increase bone mineralization remains to be established. Ectopia lentis may require aphakic contact lenses or spectacles; surgical intervention, such as lensectomy, may be indicated, and though there is controversy about the utility of implantation given the limited postoperative capsular support [68], intraocular lens implants may be considered.
Radiogrammetry
Published in Stanton H. Cohn, Non-Invasive Measurements of Bone Mass and Their Clinical Application, 2020
The correlations of these radiogrammetric measurements with the true bone mineral content of the same sections are moderately good, reflecting the imperfect geometry and variations in the composition of compact bone (mineralization, intracortical porosity). Kivilaakso and Palolampi20 found that the relative cortical thickness of the ulna (C/W) correlated significantly (r = 0.81) with its dry weight; good correlation was also found by Helelä21 between the combined cortical thickness of the metacarpals and their ash content. Horsman and Kirby22 correlated the midmetacarpal ash content per unit length with combined cortical thickness and cross-sectional cortical area and obtained significant correlations of 0.68 and 0.78, respectively.
Risk factors for fractures following liver transplantation: a population-based cohort study
Published in Annals of Medicine, 2023
Jei-Wen Chang, Hui-Hsin Yang, Niang-Cheng Lin, Fang-Cheng Kuo, Tzu-Ching Lin, Hsin-Lin Tsai
Vitamin D is important for calcium homeostasis and bone mineralization. Chronic obstructive liver disease may interfere with vitamin D metabolism, leading to decreased uptake of vitamin D. In addition, cirrhosis has been shown to impair 25-hydroxylation of vitamin D, consequently resulting in significantly depressed levels of 25-hydroxyvitamin D3 [23]. Previous studies have reported that prophylactic bisphosphonate treatment is effective in preventing bone loss and fractures in liver transplant recipients [24,25]. In the present study, we found that the use of bone protective medications including bisphosphonates, vitamin D supplements and calcium supplements did not have a beneficial effect on decreasing the risk of fractures. However, we only analyzed prescribed calcium and vitamin D supplements, and we did not consider those that could have been bought over the counter or obtained via dietary intake.
Training with FES-assisted cycling in a subject with spinal cord injury: Psychological, physical and physiological considerations
Published in The Journal of Spinal Cord Medicine, 2020
Charles Fattal, Benoit Sijobert, Anne Daubigney, Emerson Fachin-Martins, Brigitte Lucas, Jean-Marie Casillas, Christine Azevedo
The great difference between the FES-driven recumbent bike and the cycle ergometer is the need to control the stimulation pattern of the bike with regard to the terrain — trajectories (e.g., turns), surfaces, topography — and the cycles of crank rotation.6 The literature on the physiological and functional benefits of FES-assisted recumbent bike pedaling is sparse. One study showed strong evidence that FES-assisted pedaling improved bone mineral density (BMD) in children 5–13 years old.6 Many other studies have demonstrated a similar positive effect on bone demineralization, as well as on muscle atrophy, cardiovascular adaptations and carbohydrate metabolism.5,7,13–15 Most often, these studies have dealt with stationary bikes or ergometers, and it should be noted that overall the methods did not produce results that fully matched the expectations. The only controlled study comparing a cycling + FES group of patients with paraplegia and another group of patients with paraplegia in functional rehabilitation was performed using an ergometer.8 The strength of this study was its finding of significant improvement in body composition, FES-induced muscle strength, quality of life, intestinal transit, and LDL cholesterol. Muscle volume, BMD and many other parameters were not altered. In another hybrid approach, the combination of arm cycling and FES-assisted pedaling, like on rowing in order to work both upper and lower limbs, did not offer greater benefits than foot pedaling under electrostimulation alone.16,17
The safety of treating newly diagnosed epilepsy
Published in Expert Opinion on Drug Safety, 2019
As a second example of changes in clinical practice improving AED safety, changes in pharmacokinetics and pharmacodynamics of AEDs in the elderly mean choice of AED can be complex [71]. Limited clinical trial data suggests newer generation AEDs such as lamotrigine and levetiracetam have better tolerability [75], but valproate and carbamazepine still continue their pre-eminence in prescription rates amongst the elderly [83]. Both agents cause bone demineralization, but several strategies to manage this have gained popularity, even in the absence of strong evidence proving efficacy. These include bone densitometry in those with fractures, on enzyme-inducing AEDs or other risk factors, dietary and lifestyle modification, vitamin D and calcium supplementation, and bisphosphonate therapy where indicated [84,85].