The Association Between Antiepileptic Drugs and Bone Disease.

A growing body of literature indicates an association between antiepileptic drugs (AEDs) and bone disease, including histologic, radiographic, and biochemical evidence. The AEDs most commonly reported to cause decreased bone mineral density and disorders of bone metabolism are inducers of the cytochrome P450 enzyme system (phenobarbital, phenytoin, carbamazepine, primidone). More recent studies also suggest that valproate, an enzyme inhibitor, causes abnormalities in bone health. Multiple mechanisms have been postulated to support the association; however, no single mechanism explains all the findings. Identifying bone disease in persons with epilepsy receiving AEDs is important, as multiple treatment options are available.