ADHD medications associated with low bone density of the lumbar spine in children

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Children and adolescents who take medication for attention-deficit hyperactivity disorder (ADHD) show decreased bone density of the lumbar spine, among other areas, according to a large cross-sectional study presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

“This is an important step in understanding a medication class, that is used with increasing frequency, and its effect on children who are at a critical time for building their bones,” said senior study author Jessica Rivera, an orthopaedic surgeon with the US Army Institute of Surgical Research, San Antonio, Texas.

In this study, researchers identified 5,315 paediatric patients in the CDC’s National Health and Nutrition Examination Survey (NHANES) and compared children who reported taking ADHD medications with survey participants not on these medications. The results indicate that children on ADHD medication had lower bone mineral density in the femur, femoral neck and lumbar spine. Approximately 25% of survey participants on ADHD medication met criteria for osteopenia, a condition characterised by lower than normal peak bone density, and this was significantly higher compared to participants not on medication.

Medications used by patients in the study were: methylphenidate (Ritalin), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), atomoxetine (Strattera) and lisdexamfetamine (Vyvanse). These medications can also cause gastrointestinal problems such as decreased appetite and stomach upset, which may result in poor nutrition and reduced calcium intake. The drugs may diminish bone density because they alter the sympathetic nervous system.

Rivera says that because most skeletal growth occurs by ages 18-20, physicians should realise the potential threat that ADHD medications pose to maturing bones, and consider nutritional counselling and other preventative measures.

In addition, “Parents of patients taking ADHD medications should be informed of potential bone loss, especially if the findings of this study are validated in prospective studies,” says Rivera.

The study’s statistical model ruled out other potential causes of low bone density including age, sex, race/ethnicity and poverty levels. The study did not take into account information on medication dose, duration of use, or changes in therapy because of the limitations of the NHANES survey data.

This study recently appeared in the online edition of the Journal of Pediatric Orthopaedics.