What does gabapentin do to your bones?

October 8, 2025 •

4 min read

Studies indicate that gabapentin use is associated with a significantly increased fracture incidence, in some cases two to six-fold [1.2.1]. This raises an important question for millions of users: what does gabapentin do to your bones and what are the long-term risks?

Quick Summary

Gabapentin, a widely used medication for nerve pain and seizures, has been linked to adverse skeletal effects. Research shows it is associated with an increased risk of fractures, particularly hip fractures, and may negatively impact bone mineral density.

Key Points

Increased Fracture Risk: Gabapentin use is associated with a significantly higher risk of fractures, particularly hip fractures [1.3.1, 1.2.1].
Negative Bone Remodeling: The drug may negatively affect bone health by decreasing bone formation and increasing bone resorption [1.4.1, 1.6.2].
High-Risk Groups: The risk is most pronounced in older adults, frail individuals, and patients with chronic kidney disease (CKD) [1.3.1, 1.3.2].
Mechanism of Action: The negative effects may be due to impaired bone mineralization, interference with Vitamin D activity, and an increased risk of falls from CNS side effects [1.2.1, 1.5.6, 1.2.5].
Mitigation Strategies: Patients can protect their bones through calcium and vitamin D supplementation, a balanced diet, weight-bearing exercise, and fall prevention measures [1.8.1, 1.8.2].
Patient Monitoring: Regular monitoring of bone mineral density may be recommended for patients on long-term gabapentin therapy to prevent fractures [1.8.3].
Dose-Response Relationship: Some studies have found a dose-response relationship, with higher doses of gabapentin associated with a greater risk of falls or fractures [1.3.4].

Understanding Gabapentin and Its Primary Uses

Gabapentin is a prescription anticonvulsant medication originally developed to treat epilepsy by reducing abnormal electrical activity in the brain [1.9.1, 1.9.5]. It is a structural analog of the neurotransmitter gamma-aminobutyric acid (GABA) [1.2.3]. Over time, its use has expanded significantly. Today, it is commonly prescribed to manage nerve pain (neuropathic pain), such as the pain that occurs after a shingles infection (postherpetic neuralgia) [1.9.2, 1.9.3]. It is also used off-label for a variety of conditions, including diabetic neuropathy, fibromyalgia, restless legs syndrome, and anxiety disorders [1.9.1, 1.9.4]. Given that it is prescribed to millions of patients, understanding its full side-effect profile is critical [1.2.1].

The Link Between Gabapentin and Bone Health

Emerging evidence from multiple studies suggests a concerning association between the use of gabapentin (and related drugs called gabapentinoids) and negative effects on bone health. The primary concerns revolve around a decrease in bone mineral density (BMD) and a subsequent increase in the risk of fractures [1.2.4, 1.6.5].

A 2024 study published in JAMA Network Open found that gabapentinoid use was associated with a 1.3-fold increased odds of hip fractures, even after adjusting for other factors [1.3.1, 1.3.2]. The risk was notably higher in patients who were frail or had chronic kidney disease (CKD) [1.3.1, 1.3.3]. Another study highlighted that gabapentin use is linked to a 2 to 6-fold increased fracture incidence [1.2.1]. This risk isn't limited to hip fractures; studies have also found an association with non-traumatic fractures in general for individuals over 50 [1.6.6].

How Does Gabapentin Affect Bones?

The precise mechanisms through which gabapentin impacts bone health are still under investigation, but research points to several potential pathways:

Decreased Bone Formation and Increased Resorption: Animal studies have shown that gabapentin may induce a rarefaction (thinning) of cancellous bone. This effect is associated with a decrease in bone formation parameters and an increase in bone resorption parameters, meaning old bone is broken down faster than new bone is created [1.4.1, 1.6.2].
Impaired Mineralization: Research suggests that gabapentin may interfere with bone mineralization—the process of depositing calcium and phosphate to create strong bone tissue. This could be a downstream effect of the drug's interaction with the α2δ-1 subunit, its primary receptor [1.2.1, 1.4.3]. This interference may lead to conditions like osteomalacia (softening of the bones) [1.2.1].
Vitamin D Metabolism: Some antiepileptic drugs are known to interfere with vitamin D activity, which is crucial for calcium absorption and bone health [1.5.5]. While direct interactions between gabapentin and vitamin D supplements are not typically found, some sources suggest that medications like gabapentin can alter vitamin D activity, potentially contributing to bone loss [1.5.6, 1.4.2].
Central Nervous System Effects: Gabapentin's side effects include dizziness, drowsiness, and loss of coordination, which can increase the risk of falls [1.9.3]. Falls are a major cause of fractures, especially in older adults or those with already weakened bones. This provides an indirect mechanism for the increased fracture rates seen in users [1.2.5].


Factor	Potential Impact of Gabapentin on Bone Health	Supporting Evidence
Fracture Risk	Associated with a 1.3 to 2.4-fold increased risk of hip fractures, especially in frail or CKD patients.	[1.3.1, 1.3.3]
Bone Remodeling	May decrease bone formation and increase bone resorption, leading to net bone loss.	[1.4.1, 1.6.2]
Mineralization	Can impair the mineralization process, potentially leading to osteomalacia (soft bones).	[1.2.1, 1.4.3]
Fall Risk	Side effects like dizziness and unsteadiness can increase the risk of falls, leading to fractures.	[1.2.5, 1.9.3]

Populations at Higher Risk

While anyone taking gabapentin may be at risk, some populations are particularly vulnerable:

Older Adults: Age is an independent risk factor for osteoporosis and fractures. The side effects of gabapentin can exacerbate this risk [1.3.2].
Frail Individuals: A 2024 study showed a significantly higher association between gabapentinoid use and hip fractures in patients with higher frailty scores [1.3.1].
Patients with Chronic Kidney Disease (CKD): Gabapentin is cleared by the kidneys. In patients with CKD, the drug can accumulate, potentially amplifying side effects and risk. The hip fracture risk was found to be 2.4 times higher in gabapentinoid users with CKD [1.3.1, 1.3.3].
Patients with Inflammatory Arthritis (IA): This group already has an increased baseline risk of fractures. One study found current gabapentinoid use was associated with a 36% increased odds of fracture in IA patients compared to past users [1.2.5, 1.7.2].

Mitigating the Risks: What Can Be Done?

For patients on long-term gabapentin therapy, proactive measures are essential. Physicians may recommend monitoring for bone mass loss [1.8.3]. General strategies to support bone health are also crucial:

Dietary and Lifestyle Modifications: Ensuring a well-balanced diet rich in calcium and protein is fundamental. Good sources of calcium include dairy products, fish with bones (like sardines), almonds, and dark leafy greens [1.8.4]. Regular weight-bearing exercise, avoiding smoking, and limiting alcohol intake are also recommended [1.8.2].
Calcium and Vitamin D Supplementation: Since antiepileptic drugs can affect vitamin D, supplementation is often advised. Prophylactic Vitamin D doses, along with adequate calcium intake, can help support bone health [1.8.1]. It is important to have serum 25(OH)D levels checked to guide appropriate supplementation [1.8.1].
Fall Prevention: Given the CNS side effects, patients should be aware of the increased risk of falls. Strategies to prevent falls, especially for the elderly, are an important part of reducing fracture risk [1.8.1].
Medication Review: Patients should have regular reviews with their doctor to ensure gabapentin is still the most appropriate medication and is being used at the lowest effective dose. This is particularly important for high-risk populations [1.8.3].

Conclusion

The available evidence strongly suggests that gabapentin poses a tangible risk to bone health, primarily by increasing the likelihood of fractures. This risk appears to stem from a combination of direct effects on bone metabolism—such as reduced bone formation and impaired mineralization—and indirect effects like an increased propensity for falls. The risk is not uniform, with older, frail individuals and those with kidney disease being most susceptible. Patients taking gabapentin, especially long-term, should discuss these risks with their healthcare provider and implement proactive strategies, including diet, exercise, and appropriate supplementation, to help protect their skeletal health.

For more information on medication-induced osteoporosis, you can consult resources from organizations like the Royal Osteoporosis Society.

Frequently Asked Questions

Studies suggest that long-term use of gabapentin is associated with a loss of bone mineral density and an increased risk of fractures, which are hallmarks of osteoporosis. It may induce rarefaction (thinning) of cancellous bone [1.6.2, 1.6.5].

The research does not explicitly state whether the bone effects are reversible after stopping the medication. Management focuses on mitigating risk during treatment through lifestyle changes, supplementation, and monitoring [1.8.1].

One major study found that gabapentinoid use was associated with a 1.3-fold increased odds of hip fracture. This risk was even higher (up to 2.4-fold) in patients with chronic kidney disease [1.3.1, 1.3.3].

Yes, supplementation with calcium and Vitamin D is often recommended for patients on long-term antiepileptic drugs like gabapentin to help prevent bone loss, alongside a balanced diet and exercise [1.8.1, 1.8.2].

Some studies suggest other antiepileptic drugs, like levetiracetam, may not affect bone mass or strength in the same way as gabapentin [1.4.1]. The best alternative depends on the individual's condition and should be discussed with a healthcare provider.

One study noted that fracture associations were strongest in those who started gabapentinoids more recently, with increased risks observed in the first few months of use [1.2.5]. However, long-term exposure is generally considered a key factor in bone density loss [1.7.5].

Yes, some studies indicate a dose-response relationship. One study found the highest risk for falls or fractures among patients prescribed 2,400 mg/day or more [1.3.4]. Another found fracture risk increased with low and high doses, but not moderate or very high doses, indicating a complex relationship [1.2.5].