San Antonio—Attention-deficit hyperactivity/disorder (ADHD) medications appear to decrease bone density in the children and adolescents who take them, according to a new study.

A presentation at the recent 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in Orlando reports that, based on conservative estimates, the difference in standardized bone mineral density measures between an ADHD medication group and a nonmedicated group ranged from –0.4855 for total femoral, –0.4671 for femoral neck, and –0.3947 for lumbar.

In fact, according to the study from the U.S. Army Institute of Surgical Research, about 25% of survey participants on ADHD medication met criteria for osteopenia, which was significantly higher compared to participants not on medication.

“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,” explained senior study author Jessica Rivera, MD, an orthopaedic surgeon with the Army Institute.

Background information in the article cites a CDC estimate that 6.4 million children were diagnosed with ADHD through 2011, with a parent-reported 3.5 million youths taking medications to treat ADHD, a 28% percent increase from 2007 to 2011.

For the study, the research team identified 5,315 pediatric 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 the medications.

Dual-energy x-ray absorptiometry (DXA) scans, which were performed for participants aged 8 to 17 years, were used to determine bone mineral density (BMD) for three regions: 1) total femur, 2) femoral neck, and 3) lumbar. Self-reported responses to questions regarding prescription drug use, which were answered by either the respondent or the respondent’s parent or guardian, were employed to determine which participants were on ADHD medications.

Medications used by patients in the study were: methylphenidate (Ritalin), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), atomoxetine (Strattera), and lisdexamfetamine (Vyvanse), according to the report.

Rivera pointed out in an AAOS press release that osteopenia in childhood has not been definitively linked to osteoporosis later in life, which increases the risk of brittle and porous bones, and ultimately, fracture risk. Study authors suggest, however, that low bone density in children theoretically could have long-term implications because bones gain mass and strength during childhood and adolescence.

Because most skeletal growth occurs by ages 18 to 20, Rivera suggests that healthcare professionals be aware of the potential threat of ADHD medications to maturing bones and consider nutritional counseling and other preventative measures.

In terms of alternative reasons for decline in bone density, the study authors note that the medications can cause gastrointestinal problems, such as decreased appetite and stomach upset, which may result in poor nutrition and reduced calcium intake. At the same time, they write, the drugs also might lower bone density because they alter the sympathetic nervous system, which plays an important role in bone remodeling, or regeneration.

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