Should vitamin D supplementation routinely be prescribed to children receiving antiepileptic medication?

You are the paediatric registrar at an epilepsy clinic. A mother of a 9-year-old patient with childhood absence epilepsy asks if he should be taking vitamin D. He is currently prescribed sodium valproate. You wonder if you should prescribe vitamin D supplementation alongside his antiepileptic medication. In children with a clinical diagnosis of epilepsy on antiepileptic drugs (AED) (population), is there evidence to suggest that they should receive supplemental vitamin D (intervention) to improve their bone health (outcome)? We searched OVID MEDLINE in June 2020 with the keywords (Child OR Paediatrics OR Pediatrics) AND (Vitamin D OR Vitamin D Deficiency OR Cholecalciferol OR Calcitriol) AND (Anti-Epileptic Drug OR Anti-Epileptic Medication OR Anti-Convulsant Drug). The search was limited to articles in English from the year 2000. Sixty-five articles were identified. Twenty articles were included after initial scrutiny and four were selected for full-text review. One further study was identified on review of article references. These were graded according to the Oxford level of evidence (table 1).1 View this table: Table 1 Summary of included studies Vitamin D deficiency is common worldwide. Vitamin D is protective for musculoskeletal health. Children treated with AED are known to have problems with bone metabolism and bone mineral density (BMD) loss. Enzyme-inducing AEDs (phenytoin, carbamazepine, primidone and phenytoin) increase vitamin D metabolism due to induction of cytochrome P450. Newer, non-enzyme-inducing antiepileptic drugs (NEIAEDs) can affect bone metabolism in a variety of ways, including stimulation of osteoclast activity, direct action on bone cells, parathyroid hormone resistance, inhibition of calcitonin secretion …