Youths who take stimulants to treat attention deficit hyperactivity disorder (ADHD) may have a lower bone density than their peers who do not take stimulants, according to a study presented at ENDO 2016.

Methylphenidate (marketed as Ritalin and others) and amphetamine are common stimulants used to treat ADHD. Previous studies have shown that stimulants may slow children’s rate of growth in height but the effect on bone health is not clear. Alexis Feuer, MD, the study’s lead investigator, aimed to examine the association between stimulant use and bone density. 

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Researchers extracted data from the National Health and Nutrition Examination Survey (NHANES). Of the 6,489 patients aged 8–20 years old who participated in NHANES 2005–2010 and had a bone density scan via dual-energy X-ray absorptiometry (DXA), they found 159 participants used stimulants and 6,330 did not use stimulants.

Stimulant users had a 5.1% lower average bone mineral content at the lumbar spine than non-users, and a 5.3% lower content at the hip. In addition, bone density was 3.9% lower in stimulant users at the spine and 3.7% lower at the hip than non-users. 

Prospective studies that examine bone density and bone mineral content at more than one point in time are needed to clearly understand the effects of stimulants on the skeleton of growing children, Dr. Feuer added. Children and adolescents that take stimulant medications may require monitoring of bone health during and after treatment. Providers can ensure patients are maintaining a healthy weight, are participating in weight-bearing exercise, and are consuming adequate calcium and vitamin D.

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