Practice patterns of neurologists regarding bone and mineral effects of antiepileptic drug therapy

Background: Antiepileptic drug (AED) therapy has been linked to bone disease that can be treated and prevented with calcium and vitamin D. However, because there have been no definitive studies on this subject, many physicians might not be aware of this association. Objective: To determine the approaches of neurologists to skeletal disorders in patients taking AEDs. Design: A self-administered mail survey. Participants: United States board-certified or board-eligible pediatric (n=404) and adult (n=624) neurologists. Main Outcome Measures: Practice patterns of neurologists regarding methods of screening for bone disorders and recommendations for treatment and prophylaxis. Results: Few pediatric (41%) and adult (28%) neurologists routinely evaluate AED-treated patients for bone and mineral disease. Of physicians who detect bone disease through diagnostic testing, 40% of pediatric and 37% of adult neurologists prescribe calcium or vitamin D, and about half (54% of pediatric and 57% of adult neurologists) refer patients to specialists. Few neurologists (9% of pediatric and 7% of adult neurologists) prescribe prophylactic calcium or vitamin D for patients taking AEDs. Conclusions: There is a lack of consensus among neurologists concerning the impact of AED therapy on bone. Because considerable evidence suggests that much of the bone pathology caused by AED therapy can be treated or prevented by administration of calcium and vitamin D, raising physician awareness of this problem could significantly improve the skeletal health of AED-treated individuals.