Attention deficit hyperactivity disorder medications and bone mineral density of adults in the United States

Lawson, Michael Jeremy; Beltran, Thomas; Padilla, Carla R.; Berry‐Cabán, Cristóbal S.; Choi, Y. Sammy

doi:10.1016/j.bonr.2022.101570

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…21,22 A recent study on a nationally representative adult sample revealed that stimulant ADHD medication usage was associated with decreased BMD in the skull and thoracic spine. 23 Another study of juvenile rats reported that high-dose MP caused a significant decrease in BMC and BMD, but these parameters were not significantly different following a recovery protocol. 14 Various mechanisms have been proposed to explain the reduction in bone density and mineralization caused by stimulants.…”

Section: Discussionmentioning

confidence: 98%

“…21,22 A recent study on a nationally representative adult sample revealed that stimulant ADHD medication usage was associated with decreased BMD in the skull and thoracic spine. 23 Another study of juvenile rats reported that high-dose MP caused a In the Control and MP-High Dose group, alkaline phosphatase (+) cells were more common (scores +++ and ++, respectively) than in the MP-Low Dose group (score +). Thus, higher levels of osteoblastic activity were observed in the Control group and the MP-High Dose group compared to the MP-Low Dose group.…”

Section: Discussionmentioning

confidence: 99%

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Effects of methylphenidate on femoral bone growth in male rats

Say,

Önger,

Say

et al. 2023

Hum Exp Toxicol

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The use of Methylphenidate (MP) can have adverse effects on bone growth and mineralization. This study aimed to investigate the underlying pathophysiology of MP-induced skeletal deficits in growing rats using stereological and immunohistochemical methods. Male rats, aged 4 weeks, were orally treated with MP through an 8-h/day water drinking protocol. The rats ( n=30) were randomly divided into three groups: MP-High Dose (30/60 mg/kg/day MP), MP-Low Dose (4/10 mg/kg/day MP), and control (water only). After 13 weeks, the femoral bones were assessed using calliper measurements, dual-energy X-ray absorptiometry, and biomechanical evaluation. The total femur volume, cartilage volume, growth zone volume, and volume fractions were determined using the Cavalieri method. Immunohistochemical analyses were conducted using alkaline phosphatase and anti-calpain antibody staining. Rats exposed to MP exhibited significant reductions in weight gain, femoral growth, bone mineralization, and biomechanical integrity compared to the control group. The total femoral volume of MP-treated rats was significantly lower than that of the control group. The MP-High Dose group showed significantly higher ratios of total cartilage volume/total femoral volume and total growth zone volume/total femoral volume than the other groups. Immunohistochemical evaluation of the growth plate revealed reduced osteoblastic activity and decreased intracellular calcium deposition with chronic MP exposure. The possible mechanism of MP-induced skeletal growth retardation may involve the inhibition of intracellular calcium deposition in chondrocytes of the hypertrophic zone in the growth plate. In this way, MP may hinder the differentiation of cartilage tissue from bone tissue, resulting in reduced bone growth and mineralization.

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Section: Discussionmentioning

confidence: 98%

“…21,22 A recent study on a nationally representative adult sample revealed that stimulant ADHD medication usage was associated with decreased BMD in the skull and thoracic spine. 23 Another study of juvenile rats reported that high-dose MP caused a In the Control and MP-High Dose group, alkaline phosphatase (+) cells were more common (scores +++ and ++, respectively) than in the MP-Low Dose group (score +). Thus, higher levels of osteoblastic activity were observed in the Control group and the MP-High Dose group compared to the MP-Low Dose group.…”

Section: Discussionmentioning

confidence: 99%

Effects of methylphenidate on femoral bone growth in male rats

Say,

Önger,

Say

et al. 2023

Hum Exp Toxicol

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“…With our study, we were able to show that the active substances modafinil, atomoxetine and guanfacine can have osteocatabolic effects by inhibiting osteogenic and chondrogenic differentiation [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Chondral/Desmal Osteogenesis in 3D Spheroids Sensitized by Psychostimulants

Wagener

Lehmann

Böker

et al. 2022

JCM

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Attention deficit hyperactivity disorder (ADHD) affects 6.4 million children in the United States of America. Children and adolescents, the main consumers of ADHD medication, are in the bone growth phase, which extends over a period of up to two decades. Thus, impaired proliferation and maturation of chondrocytes and osteoblasts can result in impaired bone formation. The aim of this study is to investigate, for the first time, the effects of the ADHD-medication modafinil, atomoxetine and guanfacine on bone growth and repair in vitro. Using two-dimensional and three-dimensional cell models, we investigated the chondrogenic/osteogenic differentiation, proliferation and viability of human mesenchymal progenitor cells. Real-time cell proliferation was measured by xCELLigence. Live/dead staining and size measurement of hMSC- and MG63 monolayer and spheroids were performed after administration of therapeutic plasma concentrations of modafinil, atomoxetine and guanfacine. Chondrogenic differentiation was quantified by RTqPCR. The chondrogenic and osteogenic differentiation was evaluated by histological cryo-sections. Modafinil, atomoxetine and guanfacine reduced chondrogenic and osteogenic differentiation terms of transcript expression and at the histological level. Cell viability of the MG63- and hMSC monolayer was not impeded by ADHD-medication. Our in vitro results indicate that modafinil, atomoxetine and guanfacine may impair chondrogenic and osteogenic differentiation in a 3D model reflecting the in vivo physiologic condition.

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The Effects of Chronic Psychostimulant Administration on Bone Health: A Review

Nowak,

Aronin,

Beg

et al. 2024

Biomedicines

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(1) Background: Methylphenidate (MP) and amphetamine (AMP) are psychostimulants that are widely prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy. In recent years, 6.1 million children received an ADHD diagnosis, and nearly 2/3 of these children were prescribed psychostimulants for treatment. The purpose of this review is to summarize the current literature on psychostimulant use and the resulting effects on bone homeostasis, biomechanical properties, and functional integrity. (2) Methods: Literature searches were conducted from Medline/PubMed electronic databases utilizing the search terms “methylphenidate” OR “amphetamine” OR “methylphenidate” AND “bone health” AND “bone remodeling” AND “osteoclast” AND “osteoblast” AND “dopamine” from 01/1985 to 04/2023. (3) Results: Of the 550 publications found, 44 met the inclusion criteria. Data from identified studies demonstrate that the use of MP and AMP results in decreases in specific bone properties and biomechanical integrity via downstream effects on osteoblasts and osteoclast-related genes. (4) Conclusions: The chronic use of psychostimulants negatively affects bone integrity and strength as a result of increased osteoclast activity. These data support the need to take this into consideration when planning the treatment type and duration for bone fractures.

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Attention deficit hyperactivity disorder medications and bone mineral density of adults in the United States

Cited by 3 publications

References 25 publications

Effects of methylphenidate on femoral bone growth in male rats

Effects of methylphenidate on femoral bone growth in male rats

Chondral/Desmal Osteogenesis in 3D Spheroids Sensitized by Psychostimulants

The Effects of Chronic Psychostimulant Administration on Bone Health: A Review

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