Various antiepileptic drugs are known to cause bone mineral density (BMD) loss in persons with epilepsy. In general population studies, physical activity has a profound effect on bone health. Vitamin D deficiency, common in persons with epilepsy, is also associated with various chronic health conditions and osteoporosis in the general population. People with epilepsy would benefit from interventional research focused on the prevention of BMD loss. Exercise, healthy dietary habits and nutritional supplementation are important for the development and maintenance of bone health as well as for the prevention of comorbid conditions that are common in epilepsy. Consensus guidelines are needed for the prevention, screening and treatment of BMD loss in epilepsy.