Bone mineral density (BMD) and content (BMC) were measured in 208 institutionalised patients with refractory epilepsy. BMD was in the osteoporotic range in 43% of males and 21% of females. BMC was reduced only in male patients. Apart from age and gender, no other factor or specific AED was particularly associated with reduced BMD or BMC. This study indicates the magnitude of the problem of bone disease in refractory epilepsy, in particular affecting young and male patients with chronic epilepsy.