ADHD Meds May Weaken Bones in Children, Adolescents

The use of attention-deficit/hyperactivity disorder (ADHD) medications in children and adolescents was associated with decreased bone mineral density (BMD) when compared with children and adolescents who were not taking any prescription medications.

“This is an important step in understanding a medication class that is used with increasing frequency, and its effect on children who are at a critical time for building their bones,” Jessica Rivera, MD, senior study author with the U.S. Army Institute of Surgical Research, said in a news release.

The study was presented recently at the American Academy of Orthopaedic Surgeons Annual Meeting in Orlando, Fla., and was published online in the Journal of Pediatric Orthopaedics.

For the case-control study, Dr. Rivera and colleagues aimed to assess whether a link exists between ADHD medication use and diminished bone health. They collected three waves of the National Health and Nutrition Examination Survey (NHANES) public-use dataset between 2005 and 2010, which totaled 5 315 children and adolescents.

Participants were aged 8 to 17 years, and had BMD assessed in three regions — total femur, femoral neck, and lumbar — with dual-energy x-ray absorptiometry.

Researchers established ADHD medications use via self-reported responses to questions regarding prescription drug use; these questions were answered either by the respondent or the respondent’s parent or guardian.

Potential causes for low BMD, such as age, sex, race/ethnicity, and poverty levels, were ruled out in statistical analysis; however, due to limitations in the NHANES survey data, the study did not factor in medication dose, duration of use, or changes in therapy.

Compared with non-medicated participants, those who were taking ADHD medications had lower standardized BMD measures in all three regions: total femoral, –0.4855 (±0.27; P<.001); femoral neck, –0.4671 (±0.27; P<.001); and lumbar, –0.3947 ( ±0.29; P<.01). Furthermore, the rate of BMDs in the osteopenic range was higher among children on ADHD medications (38.3% vs. 21.6%; P<.01).

Dr Rivera noted that since most skeletal growth occurs by ages 18 to 20 years, clinicians should realize the potential harm ADHD medications may pose to maturing bones, and consider nutritional counseling as well as other preventative measures.

“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,” she said.


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; [published online ahead of print Sept. 20].

Rivera JC. Presentation 641. Evidence of an association between ADHD medication and diminished bone health in children and adolescents. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.