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ADHD Drugs May Harm Bone Health: Study

March 04, 2016

By Megan Brooks

NEW YORK - Preliminary evidence points to "real and nontrivial" differences in bone health of children taking an attention-deficit hyperactivity disorder (ADHD) drug relative to those not on an ADHD drug.

"Prescribing physicians and parents should be aware of potential bone health risks associated with these medications," the study team concludes in an abstract presented March 3 at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting in Orlando, Florida.

According to U.S. Centers for Disease Control and Prevention (CDC) estimates, roughly 3.5 million children and teenagers take medications to treat ADHD.

Dr. Jessica Rivera, an orthopedic surgeon with the U.S. Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas, and colleagues identified 5,313 children 8 to 17 years old in the CDC's National Health and Nutrition Examination Survey (NHANES).

They found that children on ADHD medication had lower bone mineral density (BMD) in the femur, femoral neck, and lumbar spine, relative to their peers not on ADHD drugs.

Conservative estimates of the difference in standardized BMD measures between the ADHD medication group and the nonmedicated group range from -0.4855 (p<0.001) for total femoral, -0.4671 (p<0.001) for femoral neck, and -0.3947 (p<0.01) for lumbar, they report.

In addition, significantly more children on ADHD medications versus a match cohort not on ADHD medication had BMD in the osteopenic range (38.3% vs. 21.6%, p<0.01).

In an email comment to Reuters Health, Dr. Rivera said, "The association for bone density measurements and ADHD medications has not been shown before" although one recent study did show an association between ADHD medications and measurements of bone turn over. "Together these studies give some cumulative evidence that the association we identified is real."

As for mechanism, the researchers note that ADHD stimulant medications can cause gastrointestinal problems such as reduced appetite and upset stomach, which may contribute to poor nutrition and reduced calcium intake. They may also lower bone density through their actions on the sympathetic nervous system, which plays a key role in bone remodeling and regeneration.

"I think that our findings are too early to suggest a change in practice," Dr. Rivera said. "What would be needed is prospective study on children's bone health who are on ADHD medications. However, what I do believe our study allows is a good opportunity for clinicians and parents alike to make sure they are discussing their patients' and children's nutritional needs."

The study had no commercial funding and the authors have no disclosures.

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