Published on Epilepsy Action (https://www.epilepsy.org.uk) Page generated on 20/05/2014

Bone health These pages are about bone health and epilepsy in the UK. If you are looking for information about bone health and epilepsy in another country, please contact your local epilepsy organisation [1]. In this section • Introduction • How our bones grow and repair • Bone mineral density • People at risk of low bone mineral density • Some epilepsy medicines that can affect your bones • Are your bones at risk? • Being diagnosed with low bone density • Improving your bone health Introduction Studies suggest that people who take epilepsy medicines for a long time are at higher risk of thinning and breaking of bones than people who don’t take epilepsy medicines. Bone health and epilepsy looks at some of these studies. It gives some tips to protect bone health and tells you where to go for more information. Epilepsy Action has more information about epilepsy medicines [2]. How our bones grow and repair Bones are live tissue and our bones are constantly renewing themselves by two processes. One is called resorption, the other is called formation. Resorption is when old bone is removed through the bloodstream. Formation is when new bone is formed. The end result keeps our bones as strong as possible, and makes sure that any damaged bone is replaced. Ideally, bone resorption and formation should match each other, so that the amount of bone removed always equals the amount of new bone formed. However, this changes throughout life; for example resorption often exceeds formation as we grow older. This balance is made possible by various

hormones in our bodies, including vitamin D. Vitamin D is needed by the body to absorb calcium. Calcium is essential for healthy bones. Vitamin D is mainly produced in the body through exposure to sunlight. It is estimated that we need about 45 minutes of exposure (bare arms, head and neck) each week. This is often difficult in the UK and therefore maintaining good vitamin D levels requires supplementation. Bone mineral density Bone mineral density (BMD) is a measure that shows the strength of our bones at a given time. Between childhood and the age of 20 – 25 years, our bones increase in density and become stronger, bigger and heavier. This is possible by an ongoing process of growth and repair. They then stabilise until we reach middle-age, when they gradually lose strength. The stronger bones are, the less likely they are to break. People at risk of low bone mineral density Some people have a low BMD. If you have a low BMD this may cause a condition called osteoporosis. Osteoporosis affects the bones, causing them to become weak and fragile and more likely to break. Below are some possible causes of osteoporosis. • Reduced exposure to sunlight • An overactive thyroid gland • A family history of osteoporosis • Heavy drinking and smoking • Long-term use of certain medicines, including epilepsy medicines Some epilepsy medicines that can affect your bones In 2009, the Medicines, Healthcare Products Regulatory Authority (MHRA) summarised various studies of people taking epilepsy medicines, who had a risk of broken bones. They advised that people taking the following older epilepsy medicines long-term were at risk of osteoporosis or broken bones. Carbamazepine Phenytoin Primidone Sodium valproate There is very little research to show whether some of the newer epilepsy medicines can cause BMD problems. But a study looked at a group of 168 people who had taken epilepsy medicines for more than two years. All 168 people had their BMD measured, to see if they were risk of damage to their bones. The study found that as well as the older medicines listed above, people taking levetiracetam (Keppra) long-term had a high risk of their mineral bone density being lowered. This could make them higher risk for damaging

their bones. The numbers in this study were very small, and more research needs to be done. If you are worried about your epilepsy medicines affecting your bone health, speak to your doctor. Don’t stop taking your medicines, as this could cause you to have more seizures. Are your bones at risk? The National Osteoporosis Society (NOS) has developed a questionnaire so that you can assess your individual risk of developing osteoporosis. If your answers suggest you need to take measures to protect your bones, you will be given that information at the end of the questionnaire. You can also print a copy of your results to show your doctor. If you are at high risk of developing osteoporosis, your doctor may refer you for a bone density scan, known as a DEXA scan. To use the NOS questionnaire to check your risk of developing osteoporosis, go to nos.org.uk [3]. Being diagnosed with low bone density If you are diagnosed with low BMD, it doesn’t necessarily mean you have a high risk of fracture. Ask your doctor to check all your risk factors for osteoporosis and broken bones. They can help you take positive steps to improve your bone health, which may include taking Vitamin D supplements. Improving your bone health The following is suggested by NHS Choices to help make your bones as healthy as possible. Doing these things will help your BMD, but won’t guarantee you won’t develop osteoporosis. • Eat calcium-rich foods. • Get your sunshine quota. • Go easy on the protein. • Quit smoking. • Cut down the salt. • Be active. • Drink sensibly. • Maintain a healthy weight. To find out what each of these things mean, go to nhs.org.uk [4] Code: F039.03 Last Updated: August 2013 Review Due Date: August 2015

Epilepsy Action would like to thank Dr Aza Abdulla, Consultant Physician, Princess Royal University Hospital, Bromley Hospitals NHS Trust, London for his contribution to this information. Dr Abdulla has declared no conflict of interest. This information has been produced under the terms of The Information Standard [5].

Source: https://www.epilepsy.org.uk/info/osteoporosis-osteomalacia Links: [1] https://www.epilepsy.org.uk/about/international-epilepsy-organisations [2] https://www.epilepsy.org.uk/info/treatment [3] http://www.nos.org.uk/page.aspx?pid=1157&srcid=263 [4] http://www.nhs.uk/Pages/HomePage.aspx [5] https://www.epilepsy.org.uk/info/information-standard

About this publication This information is written with input from people with epilepsy and professionals. Epilepsy Action makes every effort to ensure the accuracy of information but cannot be held liable for any actions taken. If you want to know our sources, or give us feedback, contact us. Your support We hope you’ve found the information helpful. As a charity, we rely on donations. If you would like to make a donation visit www.epilepsy.org.uk/donate You can become a member of Epilepsy Action from as little as £1 a month at www.epilepsy.org.uk/join or call 0113 210 8800. Epilepsy Helpline Freephone 0808 800 5050, text 0753 741 0044, email [email protected], tweet @epilepsyadvice Contact details Epilepsy Action, Gate Way Drive, Yeadon, Leeds LS19 7XY, UK, +44 (0)113 210 8800. A registered charity (No. 234343) and company limited by guarantee (No. 797997) in England. © Copyright Epilepsy Action