Table 2.
Osteoporosis monitoring and management for patients with neurological disorders
| Disease | Monitoring | Management | ||
|---|---|---|---|---|
| Epilepsy* | • | Serum 1,25(OH)2D level at least once a year | • | Ensure adequate calcium/vitamin D intake |
| • | Serum calcium, phosphorus, PTH, and ALP levels, and DXA scans in patients with higher risk (e.g., who take AEDs) | • | Calcium and vitamin D supplements for all patients on ketogenic diet | |
| • | Serum 1,25(OH)2D level at 1, 3, 6, 9, and 12 months during the first year and then every 6 months, and DXA scan after 2 years in patients on ketogenic diet | • | Consider bisphosphonate therapy in patients with osteoporosis | |
| CP8 [7] | • | Serum 1,25(OH)2D level and urine calcium/osmolality ratio 1–2 times a year | • | Ensure adequate calcium/vitamin D intake |
| • | Serum calcium, phosphorus, PTH, ALP, and creatinine levels, X-rays of symptomatic area and/or lateral spine X-ray, DXA scan for patients with osteoporosis (fragility fracture and/or bone pain) | • | Consider bisphosphonate therapy in patients with osteoporosis | |
| DMD [91] | • | Presence of back pain or fractures at every clinical visit. | • | Ensure adequate calcium/vitamin D intake |
| • | Serum calcium, phosphorus, magnesium, ALP, PTH at baseline only (follow-up as appropriate) | • | Verify normal renal function | |
| • | Serum 1,25(OH)2D level and DXA scan at baseline and annually | • | Consider bisphosphonate therapy in patients with osteoporosis | |
| • | Lateral spine X-ray at baseline and every 1–2 years if on steroids, and every 2–3 years if not on steroids | |||
PTH, parathyroid hormone; ALP, alkaline phosphatase; DXA, dual energy X-ray absorptiometry; AEDs, antiepileptic drugs; CP, cerebral palsy; DMD, Duchenne muscular dystrophy.
*
There are currently no existing guidelines regarding the management of osteoporosis in pediatric epilepsy patients.