OR01-5 Use of Stimulant Medications and Bone Mass in Children and Adolescents: An Nhanes Study

Program: Abstracts - Orals, Poster Previews, and Posters
Session: OR01-Osteoporosis: What You Had, What You Lost, and What You Gain
Friday, April 1, 2016: 11:45 AM-1:15 PM
Presentation Start Time: 12:45 PM
Room 157 (BCEC)

Outstanding Abstract Award
Alexis Jamie Feuer*1, Ashley Thai2, Ryan T Demmer2 and Maria G Vogiatzi3
1Weill Cornell Medicine New York Presbyterian, New York, NY, 2Mailman School of Public Health, Columbia University Medical Center, NY, NY, 3Children's Hospital of Philadelphia, Philadelphia, PA
Background: Mounting evidence indicates that the sympathetic nervous system (SNS) plays a critical role in bone remodeling. In animals, SNS activation leads to loss of bone mass via norepinephrine stimulated β-adrenergic signaling. Dopamine, which inhibits norepinephrine release in vivo, also regulates bone remodeling in animals. Epidemiologic data suggests adults using β-adrenergic blocking medications have higher bone mineral density (BMD) and reduced fracture risk. However, the effect of amphetamines on bone has been little studied in adults and children. We suggest that stimulant medications, which release and block re-uptake of dopamine and norepinephrine, may affect bone mass.  Stimulant medications such as methylphenidate and amphetamine are widely used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD), an increasingly prevalent neurodevelopmental disorder that affects approximately 6.4 million children in the U.S. As adolescence and young adulthood are critical periods for bone health, it is important to assess the effects of stimulants on bone mass in this population. 

Objective: To investigate associations between stimulant use and bone mass in pediatric subjects.

Design: Cross-sectional analysis of data from the 2005–2010 National Health and Nutrition Examination Study (NHANES).

Participants: 6489 NHANES participants ages 8–20 years (mean 13.58 + 3.58).

Outcomes: Total femur, femoral neck and lumbar spine bone mineral content (BMC) and density (BMD) assessed via dual-energy X-ray absorptiometry (DXA).

Results: 159 of 6489 subjects used stimulants. Stimulant use was an independent predictor of bone mass after multivariable adjustment for age, gender, height and weight Z score, socioeconomic status, physical activity, cotinine level and race/ethnicity. Lumbar spine BMC was 5.1% lower among stimulant users versus non-users (mean difference 0.704 g, SE ± 0.02 g, p = 0.005). Lumbar spine BMD was 3.9% lower (mean difference 0.037 g/cm2, SE ± 0.001 g/cm2, p = 0.002). Femoral neck BMC was similarly negatively associated with stimulant use while BMD approached significance. Compared to nonusers, femoral neck BMC was 5.3% lower among stimulant users (mean difference 0.242 g, SE ± 0.0093 g, p = 0.009) and BMD was 3.7% lower (mean difference 0.034 g/cm2, SE ± 0.0157 g/cm2, p = 0.08). Subjects treated with stimulants for more than 6 months had lower lumbar spine BMD and BMC than those using for less than six months and non-users.

Conclusion: In this NHANES study, pediatric subjects treated with stimulants had lower DXA measurements of the lumbar spine and femoral neck compared to non-users. As stimulant medications are first-line pharmacotherapies for ADHD, their potential effects on pediatric bone health need to be clarified. These findings support the need for future prospective studies to examine the effects of stimulant use on bone mass in this population.

Disclosure: MGV: Advisory Group Member, Novo Nordisk. Nothing to Disclose: AJF, AT, RTD

*Please take note of The Endocrine Society's News Embargo Policy at https://www.endocrine.org/news-room/endo-annual-meeting/pr-resources-for-endo