Estrogen supplementation for bone dematuration in young epileptic man treated with anticonvulsant therapy; A case report

We encountered a young man treated with anticonvulsant therapy who had grea tly reduced bone mineral density. An 18-year-old man was admitted to our ho spital for shoulder pain and further evaluation of decreased bone mineral d ensity. He had been treated with anticonvulsants, including phenytoin, phen obarbital, valproic acid and zonisamide for seizures. Although testosterone was found within the normal range for adult men, the serum estrogen concen tration was below the detection limit (<10 pg/ml) and his wrist epiphyses w ere not yet closed. After 10 months of treatment with the conjugated estrog en, both his height and weight showed improvement, while his bone mineral d ensity and bone age were increased. These findings suggested that estrogen therapy had a significant effect on his skeletal growth and bone maturation in man. This is the first report showing the beneficial effect of estrogen supplementation in an epileptic man receiving treatment with anticonvulsan ts.