The Effect of Anticonvulsants on Bone Health?


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I have been very concerned with the effects of my seizure medications on bone density. I am currently taking Trileptal at varying doses for the last four years. I was diagnosed with osteopenia, the precursor to osteoporosis, last April. It was a surprise to me as I am fit and have always maintained a good diet. Any information to share?
I am aware of Dilantin being linked to bone density issues. I'm not sure about any link with Trileptal.
I had also heard this, and was concerned due to the fact that my daughter is pretty brutal to her bones when she skates. I increased her Vitamin D, but not Calcium because of other issues.

Antiepileptic Drugs
Certain anticonvulsants may cause bone loss.7 The medications most commonly associated with osteoporosis include phenytoin, phenobarbital, carbamazepine, and primidone. 3,7,8 These antiepileptic drugs (AEDs) are all potent inducers of CYP-450 isoenzymes. In one study of community-dwelling elderly women, bone loss nearly doubled in those receiving AEDs, compared to the general population.8

There are several known and proposed mechanisms for bone loss with AEDs. As mentioned previously, all of these medications induce hepatic CYP-450 enzymes, leading to rapid metabolism of vitamin D, and possibly, estrogen. AEDs are also associated with decreased fractional calcium absorption, secondary hyperparathyroidism, and increased bone turnover. 3,7,8 At therapeutic levels, phenytoin and carbamazepine have exhibited direct effects on the bone by inhibiting osteoblast cells.8 A mechanism that may be solely linked to phenytoin is the inhibition of osteocalcin secretion--a hormone that regulates calcium in the bone.7 AEDs may exhibit any combination of these effects, and the impact on bone loss can be additive if a combination regimen is used.

To combat the loss of bone mass associated with traditional AEDs, it may be advisable to use a newer AED with a lower incidence of hepatic induction.3 Long-term studies still need to be conducted to evaluate if the newer agents cause bone loss, but to date, results appear promising. Supplementation with vitamin D and calcium is essential for the prevention of bone loss in patients who may be stabilized on an older medication. Preventive doses of at least 400 international units (IU) of vitamin D and 1,000 to 1,500 mg of calcium are recommended for those at risk.3,7
sheeeesh ......... Dilantin was the first stuff I took. I was 46.
Later a decent neuro was looking at my records, saw that, pounded his desk with the records and started screaming. He was FURIOUS that a small boned, pale skinned light haired woman was ever prescribed Dilantin. Dolanting is truly horrible for bones - causing hideous osteoporosis for women AND men..

He ordered a bone density test immediately and learned that my hip bones were over age 73 and the other bones were almost as bad. I've been taking Fosamax since then and my bones have slowly but steadily improved and are in great condition now.
And I should have said that I've been taking Trileptal for a long time and either it doesn't seem to cause the osteoporosis OR the Fosamax corrects its effects too
Dilantin was known to wreck a havoc on
my teeth. I never sustained any broken
bones until late 30's when I began to
develop fractures and Doctors began to
become concerned (I was on various
AED's), and the last straw was when I
finally broke my ankle. I have to be care-
ful now. Even though my calcium level is
fine - but my bones break easily. They're
still looking into this (it's a new finding for
Broken Bones and AED'S

I posed my question about bone density and anticonvulsants because I am unable to get formidable information from my health care professionals on this subject. They seem to worry more about the liver than anything else.

I fractured my spine last spring during a yoga class while doing a very simple posture. One twist and snap! My bone density scan showed very sad, old bones. I am still in pain and am not healing quickly, which is troubling.

I do not know if this is true but I did read once that Trileptal causes a 50% greater chance of loss of density. It was an obscure neurology site so who knows its accuracy.

Thanks for sharing stories and factoids.
I did not know about it, but my mother heard something about it in radio:ponder: and said to me:
" Eh you go to the doctor as soon as possible and make a bone density test".
I did it and in my case everything was ok.
But every women taking AEDS should do it.
I'm getting a bone density scan tomorrow! Let's just see how much damage 6 years of Dilantin + a host of other AEDs and 30 years of untreated RA did to me.
Try eating calcium chews. They were handed to me during my last dexascan and they taste pretty good. I currently take 1000mg. There are also Tums if you prefer another type of source of calcium.
A Thread Within the Thread

I am finding all these responses on Bone Health very interesting. Brain, so sorry to hear all that you have endured on your AED's.

I mentioned this topic to a friend yesterday and she told me that Fosamax is now linked to "Jaw Bone Death". Might be something to look into if you are taking this medication to increase density. My doctor declined giving me Fosamax or Boniva when I got my bone density scores saying that he is just not convinced yet that there are not serious side effects to these therapies. I am trying to supplement my diet by eating calcium rich foods and natural sources of D3.

Birdbomb, please do let us know how you do on your dexascan.
Sorry to hear about your diagnosis. I know how you feel. I asked my neurologist if there was a connection between bone loss and meds and he said no. I was still concerned, asked my GP to have a density test done and low and behold I have osteopenia too.
Just like you I exercised regulary and eat healthy. The only info I can offer is a calcium supp. like Citracel, and eat more dairy products but make sure they have Vit D with it so it will help absorb the calcium. Hang in there. Sincerely, eslucas
He was FURIOUS that a small boned, pale skinned light haired woman was ever prescribed Dilantin.

I have been on dilantin for 27 years and my Neuro is adamant about me taking calcium with vitamin D. I have not had any unusual fractures, except ribs from a seizure fall and ribs/fingers from basketball.

I am a large boned, mid complexion, dark haired man. So maybe that is on my side. But I am keeping a close eye on it.

Scared to change meds right now as this is the best control I have ever had of my tonic/clonics.

Sorry - I don't know much about Trileptal.
I had bone density last week and I do have osteoporosis too. Gee..the list just keeps growing...what else. I am only 48 and my body is already giving out on me.
Doc told me to up my calcium from 500 mg to 1500 mg per day...but, I don't think I am going to stick to this..I am sick to my stomach. The doctor also gave me fosomax rx...but when I read the directions, it threw me for a loop. It says "take on empty stomach and do not eat, drink or go back to bed for 30 minutes". My keppra makes me so is very hard to wake up..I have to drink coffee for about 20 minutes before I am steady enough to take shower and run to work. I am going to try taking this rx on Saturdays...since Sundays I have to do same routine as weekday to make it to church.
This may not make sense!

As a child I had I had already started having problemsa with brittle toe nails and ingrown toe nails and hair that were paper thin and falling out! And now I severe bursitis, fibromyalgia,fms then now I have osteoporosis which is rare in men And recently diagnosed with MS so I walk around like a old man and I am 34yrs. old. All this happening makes me cry daily.:crying::crying::crying:
I, too have the problem with Trileptal and osteoporosis. I didn't figure this out until after my leg broke without any trauma. Somehow, Trileptal results in very low levels of Vitamin D, without which your bones cannot absorb calcium. You can check this by getting a blood test for 1,25 Vitamin D levels. I had a Reclast infusion to treat the problem and now take 2,000 IU Viutamin D and 1,000 mg of calcium citrate daily. My Vitamin D level has returned to normal and I'm told that the osteoporosis should reverse over time.
Hi everyone,
I know about all the side effects of AEDs as I have most of them.
The one that really bothers me the most is that after long term use (30yrs in my case) it causes a severe decrease in bone density. The dilantin eats up all the calcium in your bones.

I also have Ulcerative Colitis which I also take meds for,and I can't consume dairy products,
Dilantin is the only proven medication so far that does not have a negative reaction with my UC meds (Mesasal) therefore I have taken vitamine C, D and calcium with magnesium vitamins for two years now to help combat osteoperosis.

diagnosed with epilepsy and Ulcerative Colitis in 1979
- current meds are:

275mg dilantin/day
120mg pheonobarb/day
3,000mg Mesasol/day
Do your research on osteoporosis drugs before you go on them...they are worse than seizure meds! I tried monthly actenol, had trouble doing the weekly meds. After only two doses, I could only walk with cane. The side effects of drugs are really bad. I have just upped calcium and vitamin D.
You know...this is one of those things that doctors should know and tell you about. It isn't mentioned in the contraindications insert for triletpal anywhere; I read mine yesterday when I renewed my RX. I already know my D levels are low, my PCP tests for them regulalry cause its an endemic problem in the population around here. I take 4000 IU a day. No one has ever mentioned an issue with the trileptal though and I've been on the stuff for 7 years.
I am sorry to hear about the bone density issues many of you have and hope they can be addressed in some way. I myself am prone to fracture and have Osteoporosis from chemical damage in gestation (again caused by perscribed meds my mother took). Is Klonopin bad for bone health as I am now on it?


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