Bone Health a Concern for Some Women With Epilepsy

By Sylvia Blair
between us Staff
Posted: April 13, 2004

Forty-six year-old Jane Smith of Wenatchee, Wash., has several complex partial seizures a week. Although she currently takes one antiepileptic medication, in the past she has been on a combination of drugs to treat her seizures.

She was a veterinary technician for 20 years and now works at an elementary school. But despite her hectic schedule, she has always prioritized her health and monitoring the effects of her treatment.

"Because of my seizure meds, my primary care doctor suggested that I have a baseline bone density test," Smith said. "He also recommended that I have another in a year or two.

"I do have osteoporosis in my family history, so it's worth it to know where I stand," Smith said.

What is Osteoporosis?

Osteoporosis, thinning of the bones, is a concern for many women as they age. Bones can begin to weaken over time. Bones go through cycles, in which old bone decays and new bone is formed. Bone density and strength decreases when an imbalance in this cycle causes more bone to break down. For women with epilepsy, concern about bone health may be more pressing.

The Risks for Women

"Women are at greater risk for osteoporosis than men," according to Martha J. Morrell, M.D., author of "Women with Epilepsy: A Handbook of Health and Treatment Issues." The handbook devotes a chapter to discussion of this issue.

"For some years," Morrell writes, "physicians have been concerned that women with epilepsy are at particular risk for this condition, which is associated with bone fractures." She recommends that women with epilepsy should have bone density tests done at menopause.

Why do physicians suspect that antiepileptic drugs (AEDs) may affect bone health? Some of these medicines induce liver enzymes that interfere with the metabolism of vitamin D and calcium, which is essential for bone health, says Blanca Vazquez, M.D., assistant professor of Neurology and director of Clinical Trials at New York University Comprehensive Epilepsy Center.

"Barbiturates are strong inducers of bone disease, and women with epilepsy taking these should have a bone density test," Vazquez said. "Also, women taking antiepileptic medication for more than five years should have a bone density test."

What is a Bone Density Test?

The results of a bone density test will inform a woman and her doctor whether she has low bone mass, or osteoporosis.

There are two types of bone density tests. One measures such sites as the finger, wrist or heel. Another measures the hip, spine or total body. Both tests are simple and painless. Some tests use sound waves, while others use small amounts of radiation to determine the thickness or density of bones.

Women taking AEDs may be at increased risk for other bone health problems, including osteopenia and osteomalacia.

Osteopenia is a weakening of the mineralization of the bones and is a precursor to osteporosis, Vazquez said. If a woman has osteomalacia, it means that strong bones were never formed from childhood, according to Vazquez.

The Role of Menopause

Bone health problems may particularly affect menopausal women.

"During the menopausal years, the bone deterioration process accelerates," Vazquez said. Declining levels of estrogen are believed to play a role.

Hormone replacement therapy during menopause may benefit some women, while others may not tolerate it well. Recent reports have suggested the other health risks of this type of therapy outweigh its benefits, especially if the hormones are taken for extended lengths of time.

Taking Preventative Steps

There are a few ways women with epilepsy can minimize bone loss and osteoporosis, according to experts. These steps include a diet high in calcium, exercise and avoidance of alcohol and cigarettes.

"I have always tried to take calcium and calcium-rich food. Now I am taking Vitamin D too. I have started an exercise program at the Y. This will include weight-training," Smith said.

Editor's Note: The name of the individual with epilepsy in this article (Jane Smith) has been changed for privacy reasons.