Researchers followed 65 children with epilepsy for one year to see how seizure medications affected their bone health. They found that children taking these medications had weaker bones after one year, with lower bone density and changes in bone-related chemicals in their blood. The effect happened whether children took one medication or multiple medications. Boys seemed to be at higher risk for bone weakening than girls. These findings suggest doctors should monitor bone health in children taking seizure medications.

The Quick Take

  • What they studied: Whether medications used to treat epilepsy (seizure disorders) affect how strong children’s bones are
  • Who participated: 65 children aged 5-15 years (40 boys and 25 girls) who had just been diagnosed with epilepsy and were starting seizure medications for the first time
  • Key finding: After one year of taking seizure medications, children’s bones became noticeably weaker. Bone density decreased by about 5%, and vitamin D levels in their blood dropped significantly. This happened in both children taking one medication and those taking multiple medications.
  • What it means for you: If your child has epilepsy and takes seizure medications, their doctor should check their bone health regularly. This doesn’t mean stopping the medication—seizure control is important—but monitoring and possibly adding vitamin D or calcium may help protect their bones.

The Research Details

This was a prospective study, which means researchers followed the same children over time rather than looking backward at past records. Researchers enrolled children aged 5-15 years who had just been diagnosed with epilepsy and were starting seizure medications for the first time (called ‘drug-naïve’ because they hadn’t taken these medications before). At the beginning and after one year, doctors measured each child’s bone density using a special X-ray machine called DXA (Dual Energy X-ray Absorptiometry), which is painless and uses very little radiation. They also tested blood samples to measure bone-related chemicals like calcium, vitamin D, and parathyroid hormone.

The study tracked 65 children who completed the full year of follow-up. About 77% had generalized epilepsy (affecting the whole brain), and 65% had epilepsy with no known cause. Some children took one seizure medication (monotherapy), while others took multiple medications (polytherapy). Researchers compared bone measurements from the start to one year later to see if the medications affected bone health.

This research approach is important because it follows children over time with actual measurements rather than relying on reports or assumptions. By measuring bone density directly and checking blood chemicals that affect bone health, researchers can see exactly how seizure medications impact growing bones. This matters because children’s bones are still developing, and any damage during these years could have long-term effects on bone strength into adulthood.

This study has several strengths: it measured bone health objectively using a standard medical tool (DXA scans), it included blood tests to understand the biological mechanisms, and it followed children for a full year. However, the sample size of 65 children is relatively small, which means results might not apply to all children with epilepsy. The study was published in a peer-reviewed medical journal, meaning other experts reviewed the work. One limitation is that the study didn’t include a control group of children without epilepsy for comparison, though the researchers did compare each child to their own baseline measurements.

What the Results Show

The main finding was clear: children’s bones became weaker after one year of seizure medication treatment. Bone mineral density (a measure of how dense and strong bones are) dropped from an average of 0.656 to 0.623—about a 5% decrease. This decrease was statistically significant, meaning it was unlikely to happen by chance.

The DXA Z-score, which compares a child’s bone density to other healthy children their age, also dropped significantly. This score went from 0.50 at the start to 0.20 after one year, meaning children’s bones became weaker relative to what’s normal for their age.

Both children taking one seizure medication and those taking multiple medications showed the same pattern of bone weakening. This suggests the problem isn’t about how many medications children take, but rather about the medications themselves affecting bone health.

Blood tests revealed important clues about why this happens. Vitamin D levels dropped significantly (from 26 to 20 units), and parathyroid hormone levels increased. These changes suggest the medications interfere with how the body regulates calcium and vitamin D, which are essential for strong bones.

The study identified that boys were at higher risk for bone weakening than girls. Boys were about 4.5 times more likely to have low bone mineral density compared to girls. This is an important finding because it suggests boys taking seizure medications may need closer monitoring. The researchers also found that both bone density and vitamin D levels decreased in both the monotherapy group (one medication) and polytherapy group (multiple medications), suggesting the effect is consistent regardless of treatment approach.

Previous research has suggested that some seizure medications might affect bone health, but this study provides clearer evidence in children who are just starting treatment. This is important because it shows the effect happens relatively quickly (within one year) and in children whose bones are still developing. The findings align with earlier studies suggesting certain seizure medications interfere with vitamin D metabolism, but this study provides more detailed measurements and a longer follow-up period than many previous studies.

The study had several limitations worth noting. First, it included only 65 children, which is a relatively small group, so results might not apply to all children with epilepsy. Second, there was no control group of children without epilepsy to compare against, though researchers did compare each child to their own baseline. Third, the study didn’t track whether children took vitamin D or calcium supplements, which could have affected results. Fourth, the study only followed children for one year, so we don’t know if bone weakness continues, stabilizes, or improves over longer periods. Finally, the study didn’t measure how well children’s seizures were controlled, which might affect bone health.

The Bottom Line

Based on this research, doctors should consider monitoring bone health in children taking seizure medications, especially boys. This might include periodic DXA scans and blood tests for vitamin D and calcium. Additionally, ensuring children get adequate vitamin D and calcium through diet or supplements may help protect their bones. However, these recommendations should be discussed with your child’s neurologist, as controlling seizures remains the primary goal of treatment. The evidence suggests preventive measures are reasonable, though more research is needed to determine the best monitoring schedule and whether supplements can prevent bone weakening.

Parents and doctors caring for children with epilepsy should pay attention to these findings, particularly if the child is a boy or will be on seizure medications long-term. Children with other conditions affecting bone health (like limited sun exposure or poor nutrition) may be at even higher risk. However, this research should not discourage anyone from taking necessary seizure medications—the benefits of controlling seizures far outweigh the risks of bone weakening, which can be monitored and managed.

Based on this study, bone weakening appears to happen relatively quickly—within the first year of starting seizure medications. This suggests monitoring should begin within the first few months of treatment. If vitamin D or calcium supplements are started, it may take several months to see improvements in bone density. Long-term monitoring (every 1-2 years) is likely reasonable for children on seizure medications.

Want to Apply This Research?

  • Track vitamin D and calcium intake daily (in milligrams), along with sun exposure time (in minutes). Set reminders for supplement timing if prescribed. Log any bone-related symptoms like bone pain or fractures.
  • Work with your child’s doctor to ensure adequate vitamin D intake (through supplements, fortified foods, or safe sun exposure) and calcium intake (through dairy products, leafy greens, or supplements). Set up a reminder system for taking prescribed supplements consistently.
  • Create a health timeline to track DXA scan results and vitamin D blood test results over time. Set annual reminders for bone health check-ups with your child’s doctor. Monitor and log any changes in bone health markers or symptoms between medical visits.

This research describes an association between seizure medications and bone weakening in children with epilepsy. This information is educational and should not replace medical advice from your child’s doctor. Seizure medications are essential for controlling epilepsy and preventing serious complications. If your child takes seizure medications, discuss bone health monitoring with their neurologist or pediatrician—do not stop or change medications without medical guidance. The findings suggest monitoring and preventive measures may be helpful, but individual treatment decisions should be made with your healthcare team based on your child’s specific situation.