Children and youth who take medication for attention deficit hyperactivity disorder (ADHD) show a decrease in bone health, say the American Academy of Orthopaedic Surgeons. The study was presented on March 3, 2016, at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons and has been published in the online edition of the Journal of Pediatric Orthopaedics.
“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 Jessica Rivera, MD, senior study author, and an orthopaedic surgeon with the U.S. Army Institute of Surgical Research. “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.”
The findings indicated that children on ADHD medication had lower bone mineral density in the lumbar spine, femoral neck, and femor. Approximately 25 percent of children taking ADHD meds showed signs of lower than normal peak bone density. This number of children on meds had this condition, known as osteneopenia, is significantly higher than children who are not being medicated for ADHD. A definite link between childhood osteopenia and osteoporosis later in life, but researchers suggest that low bone density could lead to poor bone health in adulthood.
The medications used by study participants were: atomoxetine (Strattera), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), lisdexamfetamine (Vyvanse), and methylphenidate (Ritalin). Side effects can cause gastrointestinal problems such as stomach upset and decreased appetite, resulting in reduced calcium intake and poor nutrition. These drugs may lower bone density because they change the sympathetic nervous system, which plays a vital role in bone regeneration or remodeling.
The data for this study was based on the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES). Researchers examined 5,315 pediatric patients and compared some who took ADHD medications and others who did not take these meds. The study did not take into account dosage, how long the meds were used, or changes in therapy.
Dr. Rivera said that doctors should be aware of the risk that ADHD medications will decrease bone density in maturing bones, because most skeletal growth occurs in children until the age of 18 to 20. He said that doctors should consider preventative measures such as nutritional counselling.