Epilepsy medicines and problems with bone health

Am I at risk of having osteoporosis?

In 2009, the Medicines and Healthcare products Regulatory Agency (MHRA) advised that people taking some epilepsy medicines long-term were at risk of osteoporosis or broken bones. They have listed these medicines:

• Carbamazepine
• Phenobarbital
• Phenytoin
• Primidone
• Sodium valproate

However, some more recent studies suggest that other epilepsy medicines can also increase your risk of osteoporosis if they are taken for a long time.

It might be worrying to read about possible side effects. It is important that you don’t stop taking your medicines, as this could cause you to have more seizures.  You can talk to your epilepsy specialist or specialist nurse about any concerns that you have.

Epilepsy Action has more information about epilepsy medicines.

What causes osteoporosis?

Osteoporosis is caused by a loss of bone mineral density (BMD). This happens to most of us as we get older. It also affects women more than men, for example after the menopause.

Researchers are still trying to find out exactly how epilepsy medicines cause bones to lose strength and BMD.

As well as taking epilepsy medicine for a long time, other risk factors can include:

• Not spending enough time in sunlight, which is needed to make vitamin D (this is important for bone health)
• Other medical problems, such as inflammatory or hormone conditions
• Taking certain medicines, such as high-dose steroids, or anti-oestrogen tablets used after breast cancer
• Having a family history of osteoporosis, particularly a hip fracture in a parent
• Being a heavy drinker or smoker
• Not having enough calcium in your diet
• Not moving around for long periods of time (being immobile)

Managing and treating osteoporosis

Your doctor will look at all your risk factors and the results of your DEXA scan. They might prescribe one of a number of different medicines and calcium and vitamin D supplements.

There isn’t yet enough research into what treatments might help people with osteoporosis caused by taking epilepsy medicines. However, the NHS website has more information about treating osteoporosis in general.

Taking regular exercise and having a healthy, balanced diet are two things that you can do to help keep your bones healthy. The Royal Osteoporosis Society have a number of fact sheets and videos to help you exercise safely.

You might need to take extra steps to keep your bones as safe as possible, especially during seizures or falls. Epilepsy Action has more information about safety and first aid.

Osteoporosis support

The Royal Osteoporosis Society has information on prevention and treatment, local support groups and a helpline. You can watch their introduction video below ‘What is osteoporosis?’