Bone health in epilepsy

There is a growing volume of literature suggesting that chronic use of AED in patients with epilepsy significantly reduces bone mineral density (BMD) with an increased fracture risk. The causes of these associations are likely to be multifactorial. Unlike other chronic side effects, symptoms of bone loss are insidious and asymptomatic; hence they are usually not recognized, and thus untreated. Hence one needs to determine the presence of osteoporosis before the overt signs are evident to reduce fracture risk. Evaluation of bone health is mandatory for a comprehensive treatment and to provide calcium and 25-OH vitamin-D 3 supplementation if needed. The goals of epilepsy treatment are to achieve seizure freedom while minimizing adverse effects of treatment. Management goal should include a comprehensive care of the patient and this includes much more than controlling seizures.