Comprehensive Epilepsy Center
Women's Health - Bone Health 

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Background:
In women, bone reaches its’ peak density around age 25. After that, it’s down hill. Women lose 1% of bone each year until menopause, then we lose 5% of bone each year. It is very important to develop strong bones early in life to be able to avoid fractures later in life. Hip fracture has a high death rate in elderly women.

Bone Density:
The thickness of your bones, or bone density can be measured in a few ways. A heel scan is a screening test. The best test is a DEXA scan (no needles, and it only takes 10 minutes). The DEXA scan looks at your bone density at the lower back (lumbar spine) and hip. It will give you some bone scores. The most important is the T score. The T score compares your bones to other women at their peak bone mass.

T score:

• >-1.0 Normal bone
• -1.0 to –2.4 Osteopenia
• -2.5 or lower Osteoporosis

Osteopenia is thinning of the bones and indicates a higher risk for fracture. Osteoporosis is more extreme thinning and means an even higher risk for fracture.

Risks for Bone Disease:

1. Genetics-One of the most important risks is whether or not osteoporosis runs in your family. White and Asian women have a higher risk than black women.
2. Diet-Most Americans do not get enough calcium and Vitamin D in their diet. Soda, high protein, and caffeine make you lose calcium faster.
3. Exercise-Low levels of exercise increase the risk.
4. Smoking (Another reason to quit)
5. Weight-This is one disease where being thin is bad. Low body mass index means a higher risk for disease.

Bone Health and Epilepsy:
Epilepsy increases your risk for bone disease. Men and women are both affected. Certain medications are definitely linked to reduced bone health. The include Dilantin, Tegretol, Phenobarbital, and Depakote. The newer drugs are expected to be better but the have not really been studied. Some epilepsy medications reduce calcium absorption and also reduce active levels of Vitamin D. There may be other causes that we jut don’t know yet.

Our studies at Jefferson show that anyone who has been taking epilepsy medications for 5 years or more should have a DEXA scan. We looked at our patients less than age 40 (typically they would be expected to have normal bones and no one would even look). And found that about 35% have osteopenia or osteoporosis. This is anew recommendation and most doctors are unaware of it. You may need to educate your doctors.

Treatment:
The good news is that low bone density is reversible and you can actually see an improvement in your DEXA scan over time. We suggest the following treatment:

1. Obtain adequate calcium 1,200 to 1,800 mg each day. You only absorb 600mg at a time so you need to take it two to three times a day.
2. Obtain adequate Vitamin D. You need 400 to 800 IU a day.
3. Begin weight-bearing exercise. You may want to buy ankle weights and wear them whenever possible.
4. Stop smoking.
5. Limit soda and caffeine. They make your body lose calcium.
6. If you have osteoporosis, your doctor may begin a drug to reduce bone loss. The two most common medicines are Fosamax and Actonel. Luckily, they come in a once a week dose.
7. If your first scan was abnormal, repeat your scan in 18 months.