ADHD medications reduces bone health in kids

Children and adolescents who take medication for attention-deficit hyperactivity disorder (ADHD) may be at a risk of reduced bone density, warns a study.

The results indicated that kids on ADHD medication had lower bone mineral density in the femur, femoral neck and lumbar spine.

The medications can cause gastrointestinal problems such as decreased appetite and stomach upset, which may result in poor nutrition and reduced calcium intake.

The drugs also may diminish bone density because they alter the sympathetic nervous system, which plays an important role in bone remodelling, or regeneration.

"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," said Jessica Rivera, orthopaedic surgeon with the US Army Institute of Surgical Research.

Nearly 25 percent of the children who were on ADHD medication met the criteria for osteopenia -- a condition in which bone density is lower than normal peak-- and this was significantly higher compared to participants not on medication, the researchers pointed out.

A definite link between osteopenia in childhood and osteoporosis later in life, which increases the risk of brittle and porous bones, and ultimately, fracture risk, has not been established yet, the researchers explained.

However, lower bone density in children is likely to have long-term implications and may lead to poor bone health in adulthood because childhood and adolescence is when growing bones accrue mass and strength.

As most skeletal growth occurs by ages 18-20, physicians should realize the potential threat that ADHD medications pose to maturing bones and consider nutritional counselling and other preventative measures, the researchers suggested.

ADHD is a common neurobehavioural condition often diagnosed in childhood. The US Centres for Disease Control and Prevention (CDC) estimate 6.4 million children were diagnosed with ADHD through 2011.

In addition, the CDC says that parents reported 3.5 million children and teenagers taking medications to treat ADHD, a 28 percent increase from 2007--2011.

In this study, researchers identified 5,315 paediatric 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 these medications.

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

The study was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).