Epilepsy, a chronic neurological disorder affecting millions globally, necessitates long-term pharmacotherapy with antiepileptic drugs (AEDs) [1, 7]. While effective in seizure control, AEDs are increasingly recognized for their systemic side effects, particularly their detrimental impact on bone health [2, 3, 4, 5, 6, 8, 9, 10]. This cross-sectional study aimed to investigate the relationship between antiepileptic medication use, calcium metabolism, and bone mineral density (BMD) in a cohort of adult patients with epilepsy. We assessed various biochemical markers of bone turnover and measured BMD at critical skeletal sites. Our findings suggest a significant association between AED exposure, particularly with enzyme-inducing AEDs and polypharmacy, and adverse alterations in calcium homeostasis and reduced BMD. These results underscore the importance of routine monitoring of bone health parameters in patients on long-term AED therapy to facilitate early intervention and mitigate the risk of debilitating bone complications.