A. M. Parfitt
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Parfitt AM. Osteomalacia and Phenytoin Therapy. Ann Intern Med. 1995;122:632. doi: 10.7326/0003-4819-122-8-199504150-00020
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Published: Ann Intern Med. 1995;122(8):632.
TO THE EDITOR:
Contrary to the statement in a recent letter by Siddiqui , osteomalacia verified by iliac bone histologic findings after double tetracycline labeling is rare in patients treated with anticonvulsant agents who are normally active and adequately nourished [2-4]. In the only systematic studies of such patients, no case of osteomalacia was found [2, 3]. Far more common is increased bone turnover caused by secondary hyperparathyroidism, a condition that causes accelerated loss of cortical bone, particularly in the extremities . This abnormality is referred to by French  as “osteoporosis,” although vertebral fracture rates are not increased. An increase in serum alkaline phosphatase levels in a patient treated with anticonvulsant agents is an indication that serum 25-hydroxyvitamin D and parathyroid hormone levels should be measured. If the former is low or the latter high, treatment with vitamin D or one of its metabolites is needed for the duration of anticonvulsant therapy .
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