Anti-epileptic medication and bone health

Osteoporos Int. 2007 Feb;18(2):129-42. doi: 10.1007/s00198-006-0185-z. Epub 2006 Nov 8.

Abstract

Background: 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.

Rationale: 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.

Recommendations: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Anticonvulsants / adverse effects*
  • Bone Density / drug effects
  • Bone Diseases, Metabolic / chemically induced*
  • Bone Diseases, Metabolic / drug therapy
  • Child
  • Epilepsy / drug therapy*
  • Female
  • Fractures, Bone / chemically induced
  • Fractures, Bone / prevention & control
  • Humans
  • Male
  • Monitoring, Physiologic / methods
  • Osteoporosis / chemically induced
  • Osteoporosis / drug therapy
  • Risk Factors

Substances

  • Anticonvulsants