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Table 1 Proposed mechanisms contributing to AED induced bone disease.

From: Antiepileptic drugs and bone metabolism

• Vitamin D Inactivation
   • Hepatic enzyme induction
   • PXR activation
• Altered calcium metabolism (DPH)
   • ↓ Intestinal absorption
   • ↓ vitamin D mediated absorption
   • ↓ intestinal cation transport
• ↑ PTH
   • Vitamin D insufficiency
   • ↓ cellular response to PTH
• Vitamin K deficiency
• ↓ Calcitonin
• Osteoblast Inhibition
• Altered sex-steroid & SHBG metabolism
• Possible modulation of Aromatase activity
  1. Abbreviations: PXR: Pregnane X receptor, DPH: phentyoin, PTH: parathyroid hormone, SHBG: sex hormone binding globulin