HealthDay News – The use of attention-deficit/hyperactivity disorder (ADHD) medications in children may be associated with decreased total femoral, femoral neck, and lumbar spine sex-standardized bone mineral desnity (BMD)1, according to research scheduled to be presented at the annual meeting of the American Academy of Orthopaedic Surgeons.

Jessica Rivera, MD, orthopedic surgeon with the U.S. Army Institute of Surgical Research at Fort Sam Houston, Texas, and colleagues used data from the National Health and Nutrition Examination Survey (NHANES) public-use dataset, collected from 2005 through 2010.   

5,315 U.S. children ages 8 to 17 who were part of a government health survey. The prescription medications included stimulants such as Ritalin and Adderall, and nonstimulants, like Strattera.


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The team found lower bone density in the hip and lumbar spine for children on ADHD medications than children not taking them. Overall, about one-quarter of children on the medications had lower-than-normal bone density, Rivera told HealthDay News.

“I’m in no way saying that kids shouldn’t be on these medications,” Rivera said. “This is an early study and it’s not something that should change practice.


Summary and Clinical Applicability

This study analyzed results from a large, population based data set and found that children on medication for ADHD (stimulant and non-stimulant) had decreased total femoral, femoral neck, and lumbar spine BMD.1

The impact of ADHD medication, in particular stimulants, on the bone health of developing children with active epiphyseal plates has been of recent clinical interest. Prior studies conducted in experimental animal models have shown that chronic  stimulant use was associated with less mineralized appendicular bones.2  

In this study, children on medication for ADHD had decreased sex-standardized BMD in several areas.The authors conclude that these findings “suggest that there are real and non-trivial decreases in BMD for children and adolescents taking ADHD medications, as compared to similar children not taking any prescription medications. Prescribing physicians and parents should be aware of potential bone health risks associated with these medications.”

This study was limited by its retrospective design and the utilization of self-reported responses to characterize prescription drug use. Additionally, this abstract did not specify what the effects of specific doses of individual ADHD medication or treatment duration were on BMD. Further research needs to be done to elucidate whether there is a  “safe” ADHD treatment duration, during which BMD is not negatively affected.

,Summary and Clinical Applicability Statement by Corinna Panlilio Sison MD

Reference

1. Howard J, Walick K, Rivera J. Evidence of an Association between ADHD Medication and Diminished Bone Health in Children and Adolescents. Abstract 641 presented at 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, Florida.

2. Komatsu DE, Thanos PK, Mary MN, et al. Chronic Exposure to Methylphenidate Impairs Appendicular Bone Quality in Young Rats. Bone. 2012;50(6):1214-1222. doi:10.1016/j.bone.2012.03.011.