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NewsA new study finds that enzyme-inducing antiseizure medications raise the risk of osteoporosis or osteopenia by 51% — but fewer than 1 in 4 patients on these drugs are getting vitamin D supplementation. The culprit? These medications rev up liver enzymes that speed up vitamin D breakdown. Researchers are calling it a major gap between clinical guidelines and real-world practice.
A large real-world study presented at the 151st Annual Meeting of the American Neurological Association found that adults taking enzyme-inducing antiseizure medications (like carbamazepine, phenytoin, and oxcarbazepine) were 51% more likely to develop osteoporosis or osteopenia compared to those on other antiseizure drugs. The mechanism is straightforward but often overlooked: these medications activate cytochrome P450 liver enzymes, which accelerate the breakdown of vitamin D — a key player in bone health.
What's concerning isn't just the risk itself — it's how little is being done about it. Despite well-established guidelines, only 20.7% of patients on these high-risk medications received vitamin D supplementation after diagnosis, pointing to a significant disconnect between what's recommended and what's actually happening in clinics.
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Why it matters: Bone health is rarely the headline concern when managing epilepsy — but it should be on the checklist. Researchers are urging neurologists and primary care providers to routinely monitor vitamin D levels and bone density in these patients, and to coordinate care so nothing falls through the cracks.
