Stimulant use and bone health in US children and adolescents: analysis of the NHANES data

Fu, Yanan; Wang, Guan; Liu, Junhui; Li, Meng; Dong, Meng; Zhang, Chen; Liu, Xin-Jie

doi:10.1007/s00431-021-04356-w

Cited by 8 publications

(5 citation statements)

References 45 publications

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“…Many patients, parents, and providers are concerned over the potential side effects of medication types. Within stimulants, methylphenidate is known to decrease the bone density with chronic use in both animal models and human studies ( 19 , 20 ). This has been proposed as a potential cause for the increased absolute risk of fractures for patients with ADHD compared to neurotypical individuals ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Fracture rates by medication type in attention-deficit/hyperactive disorder

Sidrak

Blaakman²,

Hale³

2023

Front. Surg.

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BackgroundADHD is a condition with extensively researched increased risks of psychiatric disorders, traumatic injury, impulsivity, and delayed response times.ObjectivesTo analyze the incidences of fractures in patients with ADHD on various medication regimens.MethodsUsing the TriNetX database, we created seven patient cohorts, all of age under 25, based on medication types commonly used for ADHD. The cohorts we created were: no medication use, exclusive use of a -phenidate class stimulant, exclusive use of an amphetamine class stimulant, nonexclusive use of formations of either stimulant, exclusive use of non-stimulant medications approved for ADHD, nonexclusive use, and no medications. We then examined rates while controlling for age, sex, race, and ethnicity.ResultsThe comparison of ADHD to neurotypical individuals revealed an increased risk for all fracture types. For the controlled analysis, all but one cohort had significant differences in each fracture type compared to the baseline cohort of ADHD patients without any medication use. Patients in the “phenidate” cohort had an insignificant difference in risk of lower limb fractures. Patients in the “any medication,” “-etamine,” “stimulant,” and “not ADHD” groups all had significant decreased risks for all fracture types, with confidence intervals often overlapping between treatment modalities.ConclusionsAs patients experiment with different medication regimens, providers should be aware of the difference in risk of fracture by medication type. Our results highlight the need for continued research to better discern appropriate medication regimens with the goal of improving overall risk reduction and producing better outcomes for individuals with ADHD.

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Section: Discussionmentioning

confidence: 99%

Fracture rates by medication type in attention-deficit/hyperactive disorder

Sidrak

Blaakman²,

Hale³

2023

Front. Surg.

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“…It has been shown through recent studies that males with ADHD who were prescribed these stimulant medications, especially for more than three months, have reduced bone mineral content and BMD for the total body, especially at the lumbar spine and pelvis (femur), when compared with patients who were not prescribed these drugs [ 35 , 45 , 46 ].…”

Section: Reviewmentioning

confidence: 99%

Breaking It Down: A Systematic Review Unravelling the Impact of Attention Deficit Hyperactivity Disorder and Methylphenidate on Childhood Fractures

Garg,

Umeano,

Iftikhar

et al. 2024

Cureus

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Limb fractures are a common cause of pediatric hospital admissions and surgeries, with a significant prevalence in the United Kingdom across all injury categories. Among psychiatric conditions in children, attention deficit hyperactivity disorder (ADHD) stands out as frequently associated with fractures, particularly those involving extremities. ADHD, with diagnoses prevalent among a significant proportion of school-age children and adolescents, has witnessed a growing global incidence. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist for our systematic literature search, using various databases and specific search terms related to ADHD and fractures. We considered articles from 2018 to 2023, focusing on English language papers with free full-text access. Our selection process used the PRISMA flowchart. We began with 1,890 articles and, after deduplication, title screening, abstract assessment, and quality evaluation included nine research papers in our review. Our primary focus was on examining fracture-related outcomes in individuals with ADHD compared to those without, considering medication status. These studies encompassed various designs, with a focus on the ADHD-fracture relationship and methylphenidate’s (MPH) impact. Our study confirms that ADHD increases fracture risk and suggests that MPH may help mitigate this risk. Early ADHD detection is vital for nonpharmacological interventions. Orthopedic surgeons should proactively identify ADHD, while healthcare professionals should offer injury prevention guidance, particularly for at-risk groups.

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“…For example, children with attention-deficit/hyperactivity disorder and ARFID may be prescribed stimulant medications to manage hyperactive/inattentive symptoms, which commonly suppress appetite and may impact overall energy intake. Several studies implicate the use of stimulants in suboptimal bone health during the years preceding peak bone mass [ 50 – 52 ].…”

Section: Mediators Of Bone Deficits In Arfidmentioning

confidence: 99%

Bone health in avoidant/restrictive food intake disorder: a narrative review

et al. 2023

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Background Avoidant/restrictive food intake disorder (ARFID) is an eating/feeding disturbance characterized by severe food avoidance or restriction that results in faltering growth, nutritional deficiencies, dependence on formula supplementation, and/or significant psychosocial impairment. Compared to other eating disorders, ARFID is observed to have an earlier childhood onset and chronic course without intervention. Childhood represents a sensitive period for longitudinal growth and bone accrual, setting the stage for long-term health outcomes associated with longevity and quality of life, including risk for fracture and osteoporosis. Results This narrative review discusses published scientific literature on bone health in individuals with ARFID by describing the current understanding of ARFID’s effect on bone health, how common dietary constraints characteristic of ARFID may present unique risks to bone health, and the current clinical recommendations for bone health assessment. Reviewing what is known of clinical data from anorexia nervosa (AN) and similar cohorts, the chronicity and etiology of dietary restriction observed in ARFID are hypothesized to compromise bone health significantly. Although limited, examination of bone health in ARFID patients suggests children with ARFID tend to have shorter stature compared to healthy reference datasets and have lower bone density compared to healthy individuals, similar to those with AN. There remains a substantial knowledge gap in how ARFID may interrupt bone accrual during childhood and adolescence, and subsequent impact on attainment of peak bone mass and peak bone strength. The longitudinal effects of ARFID may be subtle and overlooked clinically in the absence of severe weight loss or growth stunting. Early identification and remediation of threats to bone mass accrual have significant personal and population-level implications. Conclusion For patients with ARFID, delayed identification and intervention to address feeding disturbances may have a long-lasting impact on various body systems and processes, including those relating to longitudinal growth and bone mass accrual. Further research employing rigorous prospective observational and/or randomized study designs are required to clearly define effects of ARFID, as well as clinical interventions aimed at addressing ARFID-related feeding disturbances, on bone accrual.

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Stimulant use and bone health in US children and adolescents: analysis of the NHANES data

Cited by 8 publications

References 45 publications

Fracture rates by medication type in attention-deficit/hyperactive disorder

Fracture rates by medication type in attention-deficit/hyperactive disorder

Breaking It Down: A Systematic Review Unravelling the Impact of Attention Deficit Hyperactivity Disorder and Methylphenidate on Childhood Fractures

Bone health in avoidant/restrictive food intake disorder: a narrative review

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