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First report of secondary hyperparathyroidism, brown tumour and fracture of neck of femur: case report A 43-year-old woman with epilepsy developed secondary hyperparathyroidism, brown tumour and fracture of the neck of her femur during treatment with clobazam, oxcarbazepine and zonisamide. The woman presented with right groin pain and immobility; she had been unable to bear weight on her right lower limb for a month. She reported painful gait in the same limb for 3-4 months before being confined to bed. For the last 7 years, she had been receiving clobazam 10mg twice a day, oxcarbazepine 600mg twice a day and zonisamide 100mg once a day [routes not stated]. X-ray of her pelvis revealed fracture of the neck of her right femur with a smooth fracture margin, and features of osteoporosis and osteomalacia. Previous X-rays 2 and 3 months before diagnosis had shown a cystic lesion within the cortical bone of her right neck of femur calcar region, in the same area where the fracture later occurred. A radiological skeletal survey revealed hot spots in different sites. Her vitamin D level was decreased, and her parathyroid hormone and alkaline phosphatase levels were elevated. The woman’s cyst was identified during total hip arthroplasty. Histopathology of the suspect area was suggestive of osteitis fibrosa cystica, which are histological features of brown tumour [outcome not stated]. Author comment: "Secondary hyperparathyroidism due to vitamin D deficiency following long-term polytherapy of antiepileptic drug ultimately leading to development of brown tumor and pathological fracture" was presented by the authors. Jain SK, et al. Unusual presentation of altered bone metabolism with long-term antiepileptic therapy: pathological fracture of neck of femur due to brown tumor at 803072529 calcer. Musculoskeletal Surgery 95: 265-268, No. 3, Dec 2011 - India

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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of secondary hyperparathyroidism, brown tumour or fracture of neck of femur associated with clobazam, oxcarbazepine or zonisamide. The WHO ADR database did not contain any reports of hyperparathyroidism secondary, brown tumour or fracture of neck of femur associated with clobazam, oxcarbazepine or zonisamide.

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Reactions 23 Jun 2012 No. 1407