Osteoporosis and fractures may increase due to hypoestrogenism in menopause and cytochrome P450 inducing AEDs. Recent studies suggest lower bone mineral density (BMD) in adults and children with epilepsy, irrespective of AED treatment. Both idiopathic epilepsy and symptomatic epilepsy are associated with reduced BMD, with the greatest reduction in symptomatic generalized epilepsy (Sheth & Hermann, 2008). However, the pathophysiological underlying mechanisms are far from understood and likely multifactorial. Potential risk or predisposing factors include physical impairment, genetic factors, AED treatment with enzyme-inducing drugs, AED polytherapy, impact of seizures on the hypothalamus-hypophysis-adrenal (HPA) axis, and vitamin D deficiency/insufficiency. As growth and sexual maturation in adolescence are regulated by a complex.
