Bone health and antiseizure drugs: diagnosis and management

There is growing evidence for the association of antiepileptic medications (AEDs) and bone disease. Increased rates of vitamin D deficiency, elevated laboratory markers of bone turnover and increased rates of osteopenia, osteomalacia and fracture have all been reported. Although most commonly attributed to anticonvulsants that induce hepatic cytochrome P450 (CYP) enzymes, recent studies suggest that valproate, a CYP inhibitor, is also problematic. Data specific to other newer AEDs are lacking. Drug-induced inactivation of vitamin D is the most widely proposed mechanism for AED-related bone disease, however, other not yet fully elucidated pathways must also contribute. There are currently no evidence-based guidelines for diagnosis or treatment of bone disease specific to persons on AED therapy. Periodic screening for vitamin D deficiency and with dual-energy x-ray absorptiometry is likely beneficial. Prophylactic supplementation with vitamin D and calcium can be considered for all patients on AEDs, unless ...