Antiepileptic Drugs Linked to Impaired Bone and Muscle Development in Children

developing long bone
developing long bone
Previous research found an association between AED use and reduced bone density in adults.

Children treated with antiepileptic drugs (AEDs) are at increased risk for fracture, decreased bone strength, and reduced muscle force compared with matched untreated controls, according to the results of a recent Australian case-control study published in Epilepsia.

A total of 23 twin, sibling, and first cousin pairs were recruited (median age, 12.9 in the treatment group [≥12 months of exposure to AED therapy] and 13.5 in the control group). All individuals received dual-energy x-ray absorptiometry (DEXA) and peripheral quantitative computed tomography (pQCT). Muscle force and balance were tested, and questionnaires were administered regarding bone health and epilepsy particulars.

Patients in the AED treatment arm had a significantly increased incidence of fractures compared with patients in the control arm (15 vs 4; P <.01). Trabecular volumetric bone mineral density assessed by pQCT at the 4% site (tibia) was reduced by 14% (P =.03) in the treatment group vs the control group. 

Moreover, patients in the AED group exerted a significantly decreased maximum force compared with body weight at the tibia vs nonusers (P <.01). No differences were observed in bone mineral parameters assessed by either DEXA or balance measures.

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The findings warrant further investigation in larger, longitudinal studies in order to validate the possible association between bone health issues in young patients receiving AED therapy.


Simm PJ, Seah S, Gorelik A, et al. Impaired bone and muscle development in young people treated with antiepileptic drugs [published online September 7, 2017]. Epilepsia. doi:10.1111/epi.13893