Epilepsy medicines and problems with bone health

Some people who take epilepsy medicines are at risk of developing osteoporosis.

This is a condition that weakens bones, making them more likely to break (fracture).

Key points

  • People taking epilepsy medicines for a long time have an increased risk of osteoporosis
  • This means you might be more likely to break a bone
  • Your doctor may give you medication and vitamins to maintain the health of your bones
  • You can ask your epilepsy specialist to review your level of risk and discuss tests that are available
Osteoporosis sounds like this


Am I at risk of having osteoporosis?

In 2009, the Medicines and Healthcare products Regulatory Agency (MHRA) advised that people taking some epilepsy medicines long-term were at risk of osteoporosis or broken bones. They have listed these medicines:

  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Primidone
  • Sodium valproate

However, some more recent studies suggest that other epilepsy medicines can also increase your risk of osteoporosis if they are taken for a long time.

It might be worrying to read about possible side effects. It is important that you don’t stop taking your medicines, as this could cause you to have more seizures.  You can talk to your epilepsy specialist or specialist nurse about any concerns that you have.

Epilepsy Action has more information about epilepsy medicines.


What causes osteoporosis?

Osteoporosis is caused by a loss of bone mineral density (BMD). This happens to most of us as we get older. It also affects women more than men, for example after the menopause.

Researchers are still trying to find out exactly how epilepsy medicines cause bones to lose strength and BMD.

As well as taking epilepsy medicine for a long time, other risk factors can include:

  • Not spending enough time in sunlight, which is needed to make vitamin D (this is important for bone health)
  • Other medical problems, such as inflammatory or hormone conditions
  • Taking certain medicines, such as high-dose steroids, or anti-oestrogen tablets used after breast cancer
  • Having a family history of osteoporosis, particularly a hip fracture in a parent
  • Being a heavy drinker or smoker
  • Not having enough calcium in your diet
  • Not moving around for long periods of time (being immobile)

Can I check my osteoporosis risk?

You can talk to your doctor about your risk of developing osteoporosis. They will look at your risk factors, including your age, sex, health, medications and lifestyle. They may refer you for a  scan to measure your bone strength. This is called a bone density (DEXA) scan. It is a short, painless procedure.

You may find out that you have ‘osteopenia’. This means that your bone density is lower than expected, but not low enough to be diagnosed as osteoporosis.

The National Institute for Health and Care Excellence (NICE) recommend that people who are taking anti-seizure medications associated with long-term side effects should have an annual review.  You can also request a review with your epilepsy specialist if you have concerns about your bone health or your condition changes.


Managing and treating osteoporosis

Your doctor will look at all your risk factors and the results of your DEXA scan. They might prescribe one of a number of different medicines and calcium and vitamin D supplements.

There isn’t yet enough research into what treatments might help people with osteoporosis caused by taking epilepsy medicines. However, the NHS website has more information about treating osteoporosis in general.

Taking regular exercise and having a healthy, balanced diet are two things that you can do to help keep your bones healthy. The Royal Osteoporosis Society have a number of fact sheets and videos to help you exercise safely.

You might need to take extra steps to keep your bones as safe as possible, especially during seizures or falls. Epilepsy Action has more information about safety and first aid.

Osteoporosis support

The Royal Osteoporosis Society has information on prevention and treatment, local support groups and a helpline. You can watch their introduction video below ‘What is osteoporosis?’

This information has been produced under the terms of the PIF TICK. The PIF TICK is the UK-wide Quality Mark for Health Information. Please contact website@epilepsy.org.uk if you would like a reference list for this information.
Published: September 2022
Last modified: October 2023
To be reviewed: August 2025
Tracking: A060.06 (previously F039)
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