ADHD Meds Linked to Bone Density Loss in Kids
Attention deficit hyperactivity disorder (ADHD) medications prescribed to children in the U.S. grew by an astounding 36 percent between 2008 and 2012, according to a 2014 Express Scripts study. A year earlier, the U.S. Centers for Disease Control reported that between 2007 and 2011 there was a 28 percent increase in prescriptions to children for ADHD drugs during that four-year span.
The reality is that more and more kids are being prescribed psychotropic (mind-altering) medications in recent years. ADHD medications are also referred to as psychostimulants. And while more current stats haven’t been made public, there is some certainty this trend has continued.
The Scripts’ report documents more than 4.8 million kids who were privately insured taking the drugs in 2012. In 2011, the CDC’s report was 3.5 million kids. This could mean a difference in survey methods or simply a jump of 1.3 million kids between 2011 and 2012.
Regardless, it is a significant number. Especially with more than 6.4 million kids being diagnosed with ADHD through 2011 according to the CDC.
Adult use of ADHD medications has also soared. During the same 2008 to 2012 period, ADHD medication use among adults rose by 58 percent.
The question that many parents undoubtedly ask is whether these drugs are safe for kids. There have been various reports that ADHD medications can produce higher blood pressure, irregular heartbeat and/or seizures. Many ADHD drugs can also decrease appetite and produce stomach and intestinal upset. Other side effects reported by ADHD drugs include insomnia, headaches, irritability, anxiety and dry mouth.
Other reports have documented that kids who take ADHD are at greater risk of becoming addicted to drugs of some sort. Most ADHD drugs are designated as Schedule II drugs under the U.S. Controlled Substances Act. This means they can be addictive.
A 2015 paper published in the Journal of the Mississippi Medical Association stated:
“It is not clear or scientifically established that the use of psychostimulants, especially in young, developing minds of children, is safe or meaningfully beneficial in the long run.”
We can now add to this uncertainty and potential adverse effects, some shocking numbers on side effects from recent research:
Amphetamine ADHD drugs riddled with adverse effects
Among ADHD drugs prescribed to kids, amphetamines are one of the most common. There are three types of amphetamines prescribed to kids: dexamphetamine, lisdexamphetamine and mixed amphetamine salts. These include Dexedrine®, Vyvanse®, Adderall® and others.
In a Cochrane review study published in 2016, University of Alberta researchers have determined that children being treated with these ADHD psychostimulants deal with plenty of side effects.
The study tracked the results of a total of 23 studies that involved 2,675 children under the age of 18. The research tracked the efficacy and risk of adverse side effects of the kids prescribed ADHD medications versus kids given placebos – clinical double-blind studies.
The studies ranged from two weeks to one year in length. Most were done in the U.S., but also some done in Europe.
In these studies, adverse side effects included decreased appetite, insomnia and other sleep problems, abdominal pain, nausea and vomiting, headaches and anxiety.
Kids taking the amphetamines had more than six times the incidence of decreased appetite – at 631 percent. Nearly four times the kids experienced insomnia when taking the amphetamine drugs – at 380 percent. And 44 percent more of the kids taking the amphetamines experienced abdominal pain.
The researchers did find improvement in symptoms from taking the medications, but the quality of the evidence was low to very low with plenty of adverse effects. The researchers also brought into question the long-term effects, psychosocial effects and the transparency of previous studies.
“Most of the included studies were at high risk of bias and the overall quality of the evidence ranged from low to very low on most outcomes. Although amphetamines seem efficacious at reducing the core symptoms of ADHD in the short term, they were associated with a number of adverse events. This review found no evidence that supports any one amphetamine derivative over another, and does not reveal any differences between long-acting and short-acting amphetamine preparations. Future trials should be longer in duration (i.e. more than 12 months), include more psychosocial outcomes (e.g. quality of life and parent stress), and be transparently reported.”
The potential of long-term effects are especially troubling when we consider the lack of research on this aspect.
As to potentially long-term effects, we can add yet another potential adverse effect of ADHD medications on the health of children taking these medications:
ADHD drugs reduce bone density
This new study was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
This study tested 5,315 kids who took part in the National Health and Nutrition Examination Survey (NHANES). The study compared .kids who were taking ADHD medications with kids who were not.
The study tested each child between 8 and 17 years old with bone mineral density scans – using dual-energy x-ray absorptiometry (DXA). The scans were done on each child’s femur, femoral neck and lumbar spine. The study also questioned each child and parent to determine whether the child was taking a medication. The researchers also compared the results to a 1,967 sub-sampling of kids.
The study found that kids on ADHD medications had significantly lower bone mineral density in the bones tested: The femur, femoral neck and lumbar spine.
The average bone densities of the ADHD medicated kids for the femor were 52 percent lower. Bone densities for the femoral neck averaged 53 percent lower. The bone densities for the lumbar region of the ADHD medicated kids averaged 61 percent lower than in the un-medicated kids.
These results were after other potential causes of bone density problems were ruled out. These include poverty levels and others.
The study also determined that a quarter of the kids taking ADHD medications had bone densities low enough to be defined as osteopenia. And over 38 percent of the kids’ bone densities on the medications approached the range of osteopenia.
What is osteopenia?
Osteopenia is a condition where the bones are less dense and more subject to fracture. This is determined by bone mineral testing.
Osteopenia is not quite as bad as osteoporosis. Osteoporosis typically occurs in older people and is the cause of many hip fractures and other broken bones. Osteopenia may not be as bad as this, but it is still bad enough to increase the risk of bone fractures. Osteopenia can easily become osteoporosis.
Osteopenia is practically unheard of in children unless they are afflicted with something like osteogenesis imperfecta – when the bones don’t develop normally. This can occur in some cases of premature infants or malnutrition during infancy.
Because the bones’ strength and density are typically created early in life, osteopenia can cause problems later. Early osteoporosis has yet to be confirmed by research, but many clinicians assume the link because osteopenia is considered the early sign of future osteoporosis.
Medications and mechanisms of bone study
There were several ADHD medications included in this research on bone density, including several studied on the amphetamine side effects research discussed earlier. The bone density study included:
• Ritalin (methylphenidate)
• Focalin (dexmethylphenidate)
• Dexedrine (dextroamphetamine)
• Strattera (atomoxetine)
• Vyvanse (lisdexamfetamine)
The research presented that these ADHD drugs alter the body’s sympathetic nervous system. The sympathetic nervous system is involved in bone remodeling and formation.
The appetite suppressant nature of some of the ADHD drugs could also have some effect upon bone health.
Senior author Jessica Rivera, MD cautioned parents of kids on these medications:
“Parents of patients taking ADHD medications should be informed of potential bone loss, especially if the findings of this study are validated in prospective studies.”
Dr. Rivera also said that because a significant amount of bone growth occurs during the teenage years, physicians should realize the potential threat that ADHD medications pose to maturing bones and consider nutritional counseling and other preventative measures.
The study did not investigate these drugs’ effects on adults, but there is no reason to believe they would not have similar effects upon bone health.
Express Scripts. Turning Attention to ADHD: U.S. Medication Trends for Attention Deficit Hyperactivity Disorder. March 12, 2014. Accessed March 5, 2016.
CDC. Annual Attention-Deficit / Hyperactivity Disorder (ADHD). Data and Statistics. Accessed March 5, 2016
Adams JG. Psychostimulants: Concerns over Long-Term Adverse Side Effects. J Miss State Med Assoc. 2015 Nov;56(11):346-7.
Punja S, Shamseer L, Hartling L, Urichuk L, Vandermeer B, Nikles J, Vohra S. Amphetamines for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2016 Feb 4;2:CD009996. doi:10.1002/14651858.CD009996.pub2.
Howard JT, Walick KS, Rivera JC. Preliminary Evidence of an Association Between ADHD Medications and Diminished Bone Health in Children and Adolescents. J Pediatr Orthop. 2015 Sep 20.
Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). ADHD medications associated with diminished bone health in kids. March 3, 2016.
Dalsgaard S, Nielsen HS, Simonsen M. Consequences of ADHD medication use for children’s outcomes. J Health Econ. 2014 Sep;37:137-51. doi:10.1016/j.jhealeco.2014.05.005.