Stimulant Medications Linked to Bone Mass Reductions in Children, Adolescents

By Frances Morin

BOSTON -- April 6, 2016 -- Use of stimulant medications in the treatment of attention deficit hyperactivity disorder (ADHD) in childhood and adolescence is associated with significant reductions in bone mass, according to a study presented here at the 98th Annual Meeting of the Endocrine Society (ENDO).

“Our research suggests that children and adolescents using stimulant medications have lower height-adjusted bone mineral content (BMC) and bone mineral density (BMD) compared with nonusers,” said Alexis Feuer, MD, Weill Cornell Medicine, New York, New York, on April 1.

Dopamine has been shown to regulate bone remodelling in animals, and while previous studies have shown higher bone mineral density and reduced fracture risk in adults taking β-adrenergic-blocking medications, the effects of amphetamines on the bone have not been well documented.

“We suggest that stimulant medications, which release and block reuptake of dopamine and norepinephrine, may affect bone mass,” said the researchers.

For the study, the researchers analysed data from 6,489 participants aged 8 to 20 years who were enrolled in the 2005 to 2010 National Health and Nutrition Examination Study (NHANES). Among the participants, 159 used stimulants.

In evaluating bone measures assessed with dual-energy x-ray absorptiometry (DXA), the researchers found that use of stimulants was independently associated with bone mass after multivariable adjustment for factors including age, sex, height and weight Z score, socioeconomic status, physical activity, cotinine level, and race/ethnicity.

Stimulant users had a lumbar spine BMC that was 5.1% lower in stimulant users than in nonusers (mean ± standard error [SE] difference, 0.704 ± 0.02 g; P = .005), and lumbar spine BMD was 3.9% lower (mean ± SE difference, 0.037 ± 0.001 g/cm2; P = .002).

In addition, femoral neck BMC was negatively associated with stimulant use, ie, 5.3% lower among users (mean ± SE difference, 0.242 ± 0.0093 g; P = 0.009) and BMD was 3.7% lower (mean ± SE difference 0.034 ± 0.0157 g/cm2; P = 0.08).

Lumbar spine BMD and BMC values were lower among those treated for >6 months than among those treated for <6 months and nonusers.

Limitations of the study include that DXA measurement of the femur can be suboptimal in paediatric patients, and the NHANES has no data available for factors such as pubertal stage, bone age, or bone turnover, said Dr. Feuer.

“As stimulant medications are first-line pharmacotherapies for ADHD, their potential effects on paediatric bone health need to be clarified,” he added.

“These findings support the need for future prospective studies to examine the effects of stimulant use on bone health in this population,” concluded Dr. Feuer.

[Presentation title: Use of Stimulant Medications and Bone Mass in Children and Adolescents: An NHANES Study. Abstract OR01-5]
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