Strategies to protect bone mass in the older patient with epilepsy.

The annual incidence of epileptic seizures rises dramatically after the age of 60. Risk factors associated with late-onset epilepsy include cerebrovascular disease, dementia, infection, trauma, and alcoholism. The dominant cause of seizures in older patients is a previous stroke, whereas a significant percentage of cases are attributed to the presence of a tumor. Normal aging is associated with an increased risk for fractures from trauma and osteoporosis. Antiepileptic medications may exacerbate this problem by adversely affecting bone metabolism and increasing the risk of falls related to drug toxicity. The patient work-up, careful prescribing, and monitoring for drug toxicity can help preserve bone integrity in patients receiving antiepileptic drug therapy.