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AEDs is perhaps justifiable and probably cost-effective, and/or screening to identify those in
need of higher vitamin D doses in keeping with the recommended 25 year ‘bone profile’.

There is insufficient evidence to justify regarding patients with epilepsy as any different from
other groups with respect to DEXA scanning and treatment, and they should thus be managed
in line with population guidance in this context. This means that for patients over 40 years,
clinicians should be asking about additional risk factors which might ‘tip the balance’ such as
prior fragility fractures, other secondary causes (of which prolonged immobility is probably
the most prevalent in the epilepsy population), and family history, noting those with other
recognised secondary causes, and where appropriate utilising the Qfracture tool to guide further
investigation and management. In terms of who should be driving this in patients with epilepsy,
national guidelines put the onus of responsibility very much in the hands of the GP to monitor
the use of medications that might be associated with falls or fracture, to ensure prescription of
calcium and vitamin D and to encourage adherence to therapy12. However, it is also known that
patients with epilepsy are less well informed on bone health issues than the general
population98, with highly variable clinical practice in this area99. It is not known whether this
reflects poor knowledge among those managing epilepsy, the higher prevalence of learning,
memory and psychosocial problems in patients with epilepsy, or that for the general physician
or indeed the specialist epileptologist managing a patient with epilepsy, bone health simply
falls down the list of priorities. However, pending additional evidence on screening, prevention
and treatment in relation to bone health in epilepsy, dependent on much needed further
research, at least for the time being, my own view is that this is an area neurologists need to
lead on, working in collaboration with GPs and local prescribing leads to better serve our
patients.

References

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