One of the most common neurodevelopmental disorders of childhood, attention deficit hyperactivity disorder is typically treated with behavioral therapy and medication. But a new study reveals a link between decreased bone density and such medications, prompting researchers to warn physicians of the potential threat these drugs can pose to kids’ developing bones.
The results of the study – which was led by Dr. Jessica Rivera, an orthopaedic surgeon with the US Army Institute of Surgical Research – were presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
According to the Centers for Disease Control and Prevention (CDC), an estimated 6.4 million children were diagnosed with attention deficit hyperactivity disorder (ADHD) through 2011.
Children with ADHD have trouble with focus and behavior, and do not grow out of it, as most children do. Symptoms of ADHD include daydreaming, forgetting things, squirming or fidgeting, talking excessively, making careless mistakes and having trouble getting along with others.
Although researchers are currently studying causes and risk factors for ADHD, they are largely unknown – though research suggests genetics may play a role.
Other possible causes and risk factors that scientists are currently investigating include brain injury, environmental exposures (such as lead), alcohol and tobacco use during pregnancy, premature delivery and low birth weight.
The CDC note that current research does not support popular views that ADHD is caused by consuming too much sugar, watching TV, or social and environmental factors, such as poverty.
In 2011, parents reported that 3.5 million children and teenagers were taking medications for ADHD, which is a 28% increase from 2007.
To further investigate how such medications could impact bone health, the researchers assessed 5,315 children in the CDC’s National Health and Nutrition Examination Survey (NHANES) and compared children who were taking ADHD medications with children who were not.
The medications the children used were: methylphenidate (Ritalin), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), atomoxetine (Strattera) and lisdexamfetamine (Vyvanse).
Results show that the children who took ADHD medication had lower bone mineral density in the femur, femoral neck and lumbar spine, compared with the children who were not on medication.
Furthermore, about 25% of the children on the medication met criteria for osteopenia, which is characterized by low peak bone density, and the researchers say this percentage was “significantly higher” than the percentage for children who were not on medication.
- In the US in 2011, less than 1 in 3 children with ADHD received both medication and behavioral therapy
- Only half of preschoolers with ADHD received behavioral therapy
- Half were taking medication; 1 in 4 were treated only with 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,” says Dr. Rivera.
She adds that although a link between osteopenia in childhood and osteoporosis in later life has not been confirmed, low bone density in children could potentially have long-term consequences, including poor bone health in adulthood, because childhood is when bones gain mass and strength.
The medications the children used can cause gastrointestinal problems, including decreased appetite and an upset stomach, which the researchers say could result in worse nutrition and decreased calcium intake.
But the drugs could also decrease bone density by altering the sympathetic nervous system, a part of the autonomic nervous system that helps with bone remodeling and regeneration.
Since most skeletal growth takes place by the age of 20, Dr. Rivera cautions physicians to be aware of the risk that ADHD medications can have for young kids with growing bones, and to think about implementing nutritional counseling or other preventive courses of action.
Medical News Today recently reported on a study that suggested, in an effort to reduce the high prevalence of osteoporosis in the population, taking vitamin D supplements in pregnancy benefits winter babies, as it can affect long-term skeletal growth and peak bone mass.