Attention deficit hyperactivity disorder medicines to lower bone density in children and adolescents

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Attention deficit hyperactivity disorder medicines to lower bone density in children and adolescents

Adolescence and young adulthood are critically essential times for accruing peak bone mass--the largest and densest bone. Failure to obtain adequate bone mass by early adulthood may result in an increased fracture risk or even the development of osteoporosis later in adulthood.

As per evidences,  medications like amphetamine and methylphenidate, which are commonly prescribed to treat children with attention deficit hyperactivity disorder (ADHD) appears to be associated with bone loss. The finding suggests that the bone health of such children should be monitored since decreased bone density during childhood and early adulthood poses a greater risk of developing osteoporosis later in life.

ADHD is the most common behavioral disorder that starts during childhood and affects focus and concentration.  According to Previous studies have found that stimulants may slow rate of height growth in children, and lower bone density (BMD) could result in increased fracture risk or the development of osteoporosis later in life.

To explore this, researchers collected data from the National Health and Nutrition Examination Study (NHANES) by the U.S. Centers for Disease Control and Prevention. NHANES assesses the health and nutritional status of a nationally representative cross-section of adults and children in the United States. Dr. Feuer and her colleagues sampled data from 6,489 NHANES participants between 2005 to 2010 who aged between 8 to 20 years. A total of 159 of 6,489 used stimulant medications and 6330 did not. Participants were scanned using an imaging technique called dual-energy X-ray absorptiometry or DXA, to evaluate BMD.

Among stimulant users, average bone mineral content was 5.1% lower at the lumbar spine and 5.3% lower at the hip than in nonusers. Similarly, BMD was 3.9% lower at the spine and 3.7% lower at the hip in stimulant users. The study findings did not prove that ADHD drugs lower BMD, therefore the authors suggested to have more research to examine the effects of these medications on growing children.

Thus, it can be summarized that children and adolescents using stimulant medications may need monitoring of their bone health during and after the stimulant treatment. Health care providers can monitor the bone health of pediatric patients by ensuring that they maintain a healthy body weight, practicing weight bearing exercise and have the adequate nutritional intake of calcium and vitamin D. At this time, routine imaging with DXA scans are not recommended.


The Endocrine Society

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Original title of  article: 

Bone density lower with use of ADHD stimulant medicine


Alexis Feuer​

Therapeutic, Methylphenidate, Amphetamine, Attention deficit hyperactivity disorder (ADHD), Bone, CNS Stimulants, Safety, DXA
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