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Osteomalacia and Phenytoin Therapy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Contrary to the statement in a recent letter by Siddiqui [1], 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 [4]. This abnormality is referred to by French [5] 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 [4].
A. M. Parfitt
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
