Osteoporosis International

, Volume 18, Issue 2, pp 129–142

Anti-epileptic medication and bone health


  • S. J. Petty
    • University of Melbourne Department of MedicineRoyal Melbourne Hospital
  • T. J. O’Brien
    • University of Melbourne Department of Medicine, Department of NeurologyRoyal Melbourne Hospital
    • University of Melbourne Department of Medicine, and Bone and Mineral ServiceRoyal Melbourne Hospital

DOI: 10.1007/s00198-006-0185-z

Cite this article as:
Petty, S.J., O’Brien, T.J. & Wark, J.D. Osteoporos Int (2007) 18: 129. doi:10.1007/s00198-006-0185-z



Epilepsy is a common chronic neurological disorder, usually requiring long-term treatment with anti-epileptic drugs (AED). Many studies have reported that AED therapy is associated with metabolic bone disease and is a major iatrogenic risk factor for fractures. There remains uncertainty about the type(s) of bone disease due to AED treatment, and the pathogenesis of AED-associated fractures.


Deficits in bone mineral density (BMD) are widely reported in AED-treated patient populations. However, much of the research conducted to date has been limited by factors such as small sample size, potentially biased subject selection, a lack of selection of appropriate control data, and failure to take account of important confounding influences. The pathogenesis of AED-associated fractures is likely to be multifactorial, due to factors including reduced BMD, impaired bone quality (due to osteoporosis and/or osteomalacia), increased propensity to fall, and fractures associated with seizures or loss of consciousness.


Patients receiving long-term AED should be monitored for indices of bone health, including BMD and vitamin D status. Lifestyle factors should be optimized, vitamin D status maintained, and fall prevention strategies introduced as appropriate. Good seizure control is important. The use of additional, specific osteoporosis therapy is not evidence-based in this setting, but would appear reasonable in patients with clinically significant decreases in BMD, applying current treatment guidelines for osteoporosis.


There is a pressing need for improved understanding of the pathogenesis of AED-associated bone disease, for better definition of the risk associated with specific AED regimens, and for the development of evidence-based preventive and treatment approaches in this common but neglected disorder.


Anti-epileptic drugsBone mineral densityEpilepsyFallsFracturesMetabolic bone disease

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© International Osteoporosis Foundation and National Osteoporosis Foundation 2006