People with epilepsy take medications to prevent seizures, but some of these drugs may weaken bones over time. Researchers reviewed what we know about how different epilepsy medications affect bone health. Some medications reduce vitamin D levels and increase bone breakdown, while others are gentler on bones. The good news is that doctors can now choose medications that are safer for bones and can test patients to catch bone problems early. Understanding which medications pose risks helps patients and doctors make better treatment choices.
The Quick Take
- What they studied: How different epilepsy medications affect bone strength and the risk of broken bones in people who take them long-term
- Who participated: This was a review of existing research, not a new study with participants. Researchers looked at what scientists already know about epilepsy medications and bone health
- Key finding: Some epilepsy medications (like phenytoin, carbamazepine, and valproic acid) can weaken bones and increase fracture risk, while others (like levetiracetam and lamotrigine) are much safer for bone health
- What it means for you: If you take epilepsy medication, talk to your doctor about which drug you’re taking and whether your bones need to be checked. Choosing a bone-friendly medication when possible, combined with regular bone health screening, can help prevent fractures
The Research Details
This is a review article, meaning researchers gathered and analyzed information from many previous studies about epilepsy medications and bone health. Instead of doing their own experiment with patients, they looked at what other scientists have already discovered and organized it into one comprehensive summary.
The researchers focused on understanding the different ways various epilepsy medications can affect bones. They examined how medications change vitamin D levels in the body, how they influence hormones that control bone breakdown and building, and how they directly impact bone cells themselves.
By reviewing all this existing research together, the authors could identify which medications are riskier for bones and which ones are safer, helping doctors make better choices when treating patients with epilepsy.
This type of review is important because it brings together scattered information from many studies into one clear picture. Doctors need this kind of summary to understand the bone risks of different epilepsy medications so they can choose the safest options for their patients. Since people with epilepsy may take these medications for years or decades, understanding long-term bone effects is crucial for preventing serious fractures later in life.
This is a review of existing research rather than a new study, so it depends on the quality of studies already published. The authors appear to have looked at established scientific knowledge about how epilepsy medications work in the body. However, readers should know that some of the underlying research may have limitations, and new studies could change our understanding. This review provides a helpful summary of current knowledge but isn’t the final word on the topic.
What the Results Show
The research shows that epilepsy medications fall into two main categories when it comes to bone health: those that increase fracture risk and those that are safer.
High-risk medications include phenytoin, carbamazepine, oxcarbazepine, eslicarbazepine, and phenobarbital. These drugs work by speeding up the body’s processing of vitamin D, which is essential for strong bones. When vitamin D levels drop, the body produces more of a hormone called PTH, which signals bones to release calcium into the bloodstream. This process weakens bones over time.
Valproic acid is particularly concerning because it reduces vitamin D in multiple ways and also directly damages bone-building cells while activating bone-breaking-down cells. Topiramate also appears to weaken bones, though scientists aren’t completely sure of the exact mechanism.
In contrast, levetiracetam has an excellent safety profile for bones. Lacosamide and lamotrigine are also relatively safe compared to other medications in their class. These bone-friendly options should be chosen whenever medically possible.
The research highlights that some epilepsy medications affect bone health by changing sex hormone levels, which also play a role in bone strength. Additionally, the timing and duration of medication use matters—people who take high-risk medications for many years face greater bone weakening than those on shorter courses. The review also notes that bone problems may not cause obvious symptoms until a fracture occurs, making preventive screening especially important.
This review confirms and organizes knowledge that scientists have been discovering over the past several decades. Previous research has shown connections between certain epilepsy medications and fractures, but this comprehensive review brings all that information together in one place. It represents the current scientific consensus on which medications are riskier and which are safer for bones.
Since this is a review of other studies rather than new research, its conclusions depend on the quality of existing studies. Some older research may have had limitations that affect the conclusions. Additionally, the review notes that for some medications like topiramate, the exact mechanism of bone damage isn’t fully understood. Individual patients may respond differently to medications, so general findings may not apply equally to everyone. Finally, this review doesn’t provide new data on how common bone problems actually are in people taking these medications.
The Bottom Line
If you take epilepsy medication: (1) Ask your doctor which medication you’re taking and whether it’s known to affect bone health (Confidence: High); (2) Discuss bone health screening, especially if you’re on a high-risk medication (Confidence: High); (3) Ensure adequate vitamin D and calcium intake through diet or supplements (Confidence: High); (4) Engage in weight-bearing exercise like walking or strength training (Confidence: Moderate); (5) If possible, work with your doctor to use bone-friendly medications like levetiracetam when medically appropriate (Confidence: Moderate).
Anyone taking epilepsy medication should be aware of potential bone effects, especially people who have been on these medications for many years, older adults, women past menopause, and people with other risk factors for weak bones. People considering starting epilepsy treatment should discuss bone safety with their neurologist. Family members and caregivers should also understand these risks to help monitor for signs of bone problems.
Bone weakening from epilepsy medications typically develops gradually over months to years of use. You won’t notice changes immediately, which is why regular screening is important. If you switch to a bone-friendly medication, improvements in bone strength take time—usually several months to years. Fracture prevention benefits from better medication choices and lifestyle changes may take 6-12 months or longer to become apparent.
Want to Apply This Research?
- Log your epilepsy medication name and dose daily, and track any bone-related symptoms like bone pain, muscle weakness, or falls. Set monthly reminders to record your calcium and vitamin D intake from food and supplements.
- Use the app to set daily reminders for weight-bearing exercise (30 minutes of walking, dancing, or strength training). Create a checklist for calcium-rich foods to eat each day (dairy products, leafy greens, fortified foods) and track vitamin D supplementation if recommended by your doctor.
- Set quarterly reminders to review your medication list and note any changes. Track any fractures, falls, or bone-related injuries. If your doctor orders bone density tests, log the results and dates in the app to monitor trends over time. Use the app to prepare questions for your neurologist about bone health at each appointment.
This review summarizes scientific research about how epilepsy medications may affect bone health. It is not medical advice and should not replace conversations with your healthcare provider. Do not change, stop, or start any epilepsy medication without consulting your neurologist, as the seizure control benefits of your current medication may outweigh bone risks. If you have concerns about bone health while taking epilepsy medication, speak with your doctor about bone screening and whether alternative medications might be appropriate for your specific situation. This information is for educational purposes and applies to general populations; individual circumstances vary.