Epilepsy-associated bone mineral density loss should be prevented

Osteopenia and bone mineral density (BMD) loss is a major public health problem in the United States, and was the subject of a 2004 Surgeon General’s report.¹ BMD loss and increased fracture risk among young adults with epilepsy is especially common—two to six times more frequent than in the general population,² and yet screening for BMD loss among children, adolescents, and young adults with epilepsy is not standard of care. Most physicians typically consider osteopenia and BMD loss as occurring primarily among white, postmenopausal women, or those with specific medical conditions such as hyperthyroidism, renal disease, alcoholism, and among those who smoke cigarettes and take corticosteroids.³ Furthermore, routine screening for BMD loss among young people with epilepsy has not been widely practiced, in part, because we do not know when to begin screening, we have not established standardized screening and treatment protocols for specific at-risk subpopulations, and there are very few specific interventions with proven efficacy in clinical trials among children and young adults with epilepsy.⁴ Prevention …