Stimulant Use for ADHD Associated With Lower Bone Density in Young People

BOSTON — Use of stimulants such as amphetamine and methylphenidate for attention-deficit/hyperactivity disorder (ADHD) may lead to loss of bone mineral content in teenagers and children.

“Children and adolescents using stimulant medications have lower bone density than their peers,” said Alexis Feuer, MD, assistant professor of pediatrics and a pediatric endocrinologist at Weill Cornell Medicine in New York.

Dr Feuer discussed results from a study of nearly 6500 young people at ENDO 2016. She cautioned that the findings do not prove that these medications cause lower bone density. Researchers need to collect more data before they can determine what impact, if any, these results might have on the roughly 6 million young people in the United States who are being treated for ADHD, she said.

Dr Feuer added that young people who took stimulants for longer than 6 months had lower bone density at the spine and hip than those assigned to those medications for less than 6 months.

“Those children taking stimulants for less than 6 months still had lower bone density than nonusers,” she said.

Previous studies have found that stimulants may slow children’s rate of growth in height, and lower bone density could result in increased fracture risk or the development of osteoporosis later in life.

Dr Feuer and colleagues analyzed data collected in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. Among 6489 people aged 8 to 20 years who participated in the survey and had a bone density scan using dual-energy X-ray absorptiometry (DXA), 159 participants used stimulants and 6330 did not.

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, bone mineral density (BMD) was 3.9% lower at the spine and 3.7% lower at the hip in stimulant users.

“I firmly believe that moving forward, clinicians caring for children taking stimulants should immediately begin screening them for bone health,” said Dr Feuer, noting that routine imaging with DXA scans is not currently recommended.

“Fortunately, a child’s bone health can be comprehensively screened through careful monitoring of their linear growth and weight gain and by ensuring that these children are engaging in adequate weight-bearing exercise and have sufficient vitamin D levels.”

She also did not recommend discontinuing the use of stimulant medications.

“The decision to take a stimulant medication is not taken lightly by doctors who are prescribing them or parents and families of patients who need them. If a child needs a stimulant medication, they 100% should be taking them,” Dr Feuer noted. “We do need prospective studies to see what effects stimulants may have with chronic treatment, but if you monitor for bone health, that should be sufficient while [these patients] are on stimulant therapy.”

Reference

1. Feuer AJ, Thai A, Demmer RT, Vogiatzi MG. OR01-5: Use of Stimulant Medications and Bone Mass in Children and Adolescents: An NHANES Study. Presented at: ENDO 2016; April 1-4, 2016; Boston, MA.