Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

[Arterial aging is a physiologic process co­existing with general aging of the human body, however arterial age of a given individual can be different from his chronologic age. The underlying causes are determined by genetic factors, cell biologic processes and several risk factors. While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Therefore, it is necessary to refine the risk stratification at an individual level, the tools for this are biomarkers. Biomarkers are surrogate endpoints, which precede, substitute the real, hard endpoint clinical events. It has been proposed that nume­rous potential vascular biomarkers would have a role in primary and secondary cardiovascular prevention. Most of them fit in the concept of early vascular aging (EVA). Only carotid ultrasonography, ankle-brachial index and carotid-femoral pulse wave velocity meet perfectly the strictest criteria against the biomarkers. The process of arterial aging may be decelerated and benefi­cially influenced with non-pharmacologic and pharmacologic treatment strategies.]

[The continued high morbidity of cardiovascular diseases justifies the exploration of “residual” risk factors. During embryonic development, the cardiovascular organs, bones, muscles, kidney, and adipose tissue differentiate from the mesoderm, the remaining humoral and mechanical communication between cell lines partly explains the phenomenon of residual cardiovascular risk, and partly leads to the delineation of new therapeutic targets. Among the common factors in the pathogenesis of osteoporosis and atherosclerosis, inflammation can be highlighted, which makes the beneficial effects of biological therapy treatment understandable. The Klotho system and the AGE-RAGE axis are responsible for age-related systemic changes. Cardiokines, myokines, osteokines, adipokines, and hepatokines are molecular mediators of complex interactions between individual organs. In particular, the cardio-renoprotective effects of the GLP-1RA and SGLT2i drug classes already used in diabetology are part of the systemic beneficial effect. Similarly, blocking mineralocorticoid receptors with finerenone has a generalized anti-inflammatory, anti-oxidant and anti-fibrotic effects. Regular exercise has always been recommended for cardiovascular patients, but now more and more mechanisms are becoming known that highlight the role of skeletal muscle in regulating the entire metabolism. Simultaneous use with the diet, it can be a simple and effective method to control the progression of cardiovascular disease.]

[In August 2021, the European Society of Cardiology and 12 other scientific societies published their guidelines on “Prevention of cardiovascular disease in clinical practice”. The guidelines provides a comprehensive review of the risk factors of atherosclerotic cardiovascular disease, their assessment, potential risk factors modifiers, treatment of risk factors, and prevention of cardiovascular disease at the societal and individual level. The previous guidelines, issued in 2016, needed to be updated due to recent significant advances in the prediction of the risk of atherosclerotic origin cardiovascular disease and the beneficial effects of treatment, the emergence of new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can now be presented in a lifetime perspective, which will help to make a personalised, shared decision on the extent of interventions, taking into account the patient’s preferences. The new guidelines also present in detail the cardiovascular risk modifiers, co-morbidities, the principles of personalised treatment, and prevention at the individual and societal level.]

[Introduction: The frequent occuring of traumatic events resulting from falls among the patients with osteoporosis and their negative consequencies to the life quality make the application of efficient movement therapy interventions for preventing falls. The aim of the study: The authors’ purpose is to revise the effectiveness of movement therapy interventions regarding osteoporosis, mainly in the field of balance training and fall prevention. We carried out a detailed systematic literature reasearch in the database of Ebsco Discovery Service concerning the period of January 2014 and December 2019. We only searched for articles available in full and in English language using appropriate keywords. We found 42 publications potentially relevant, of which 12 met the inclusion criteria. The programs performed in different media, intensity and time period highlighted the significance of each exercise form in the functional variables. The different exercise programs prove to be effective for muscle and balance training as well as there is a growing number of evidences which emphasize the role of multimodal programs.]