Annals of Indian Academy of Neurology
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Year : 2006  |  Volume : 9  |  Issue : 2  |  Page : 90-97

Epilepsy, antiepileptic drugs and bone health

1 Departments of Neurology, Amrita Institute of Medical Sciences, Cochin - 682 026, Kerala, India
2 Departments of Endocrinology, Amrita Institute of Medical Sciences, Cochin - 682 026, Kerala, India

Correspondence Address:
K P Vinayan
Department of Neurology, Amrita Institute of Medical Sciences, Cochin - 682026, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-2327.25980

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There is a growing body of literature, describing disorders of bone health in epilepsy. Patients with epilepsy have a higher incidence of skeletal fractures due to multiple reasons. Postmenopausal women and elderly men are particularly vulnerable to osteoporosis. A major convulsive seizure can often lead to falls and may result in fractures. Antiepileptic therapy may have seemingly contradictory effects on bone health. It can effectively reduce the incidence of major seizures and prevent the seizure related falls and fractures. However, the central nervous system effects of these drugs increase the risk of falls, especially in the vulnerable population. Long-term antiepileptic therapy may lead to a reduction in bone mineral density, with consequent increase in bone fragility. This can increase the risk for fractures with attendant high morbidity and mortality. Dual energy X-ray absorptiometry (DXA) is currently the gold standard for assessing bone mineral density. Multiple pathophysiologic mechanisms have been proposed for the reduction in bone mineral density associated with antiepileptic therapy. Most of the available data are from the patients treated with conventional antiepileptic drugs (AED). There is a need for monitoring the effects of the newer AEDs on the bone mineral metabolism. This is of added significance in view of an ageing population and also an increase in the prevalence of epilepsy in the elderly. Physicians treating patients with epilepsy should be made aware of this problem and adequate preventive measures should be advised especially in patients with multiple risk factors. A multidisciplinary approach with the help of an endocrinologist may be needed in severe bone disease.

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