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Stimulant Use and Bone Mineral Density

Stimulant Use and Bone Mineral Density To the Editor In the cross-sectional analysis of the National Health and Nutrition Examination Survey data comparing 159 children treated with stimulants for attention-deficit/hyperactivity disorder with 6330 control children, Feuer et al1 found that lower bone mass and bone density was associated with stimulant use and postulated that stimulants lower bone mass by modulating β-adrenergic signaling to osteoblasts to stimulate bone resorption and suppression bone formation.1 However, stimulant treatment has also been associated with reduced growth velocities and weight loss,2 and there was a significant discrepancy in weight between the 2 groups, with children using stimulants having lower weight, as well as lower weight for age, compared with their nonstimulant counterparts. Given that weight is a major determinant of bone mineral density and mediates its effect via loading of weight-bearing bones,3 this could potentially account for the difference in bone mass with stimulant treatment. We therefore suggest that the actual weight is likely to be of far greater relevance to include in the analysis than age or growth parameters corrected for age (ie, height and weight z scores). While it is important to be aware of the adverse effects of stimulant medication, these should not be artifactually exaggerated. We urge the authors to repeat their multivariate linear analysis using actual weights instead of age and z scores. This may establish whether the lower bone density in children using stimulants could in fact not be pathological as the authors appear to suggest but actually be appropriate for their weight. Back to top Article Information Corresponding Author: Karen N. W. Lee, MBBS, Nepean Hospital, PO Box 63, Penrith, New South Wales 2751, Australia (klee5298@uni.sydney.edu.au). Published Online: March 27, 2017. doi:10.1001/jamapediatrics.2017.0180 Conflict of Interest Disclosures: Dr Poulton reports personal fees and nonfinancial support from Shire outside the submitted work and shares in GSK. No other disclosures are reported. References 1. Feuer AJ, Thai A, Demmer RT, Vogiatzi M. Association of stimulant medication use with bone mass in children and adolescents with attention-deficit/hyperactivity disorder. JAMA Pediatr. 2016;170(12):e162804. doi:10.1001/jamapediatrics.2016.2804PubMedGoogle ScholarCrossref 2. Swanson J, Greenhill L, Wigal T, et al. Stimulant-related reductions of growth rates in the PATS. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1304-1313.PubMedGoogle ScholarCrossref 3. Boot AM, de Ridder MA, Pols HA, Krenning EP, de Muinck Keizer-Schrama SM. Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab. 1997;82(1):57-62.PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Pediatrics American Medical Association

Stimulant Use and Bone Mineral Density

JAMA Pediatrics , Volume 171 (5) – May 1, 2017

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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2017 American Medical Association. All Rights Reserved.
ISSN
2168-6203
eISSN
2168-6211
DOI
10.1001/jamapediatrics.2017.0180
pmid
28346594
Publisher site
See Article on Publisher Site

Abstract

To the Editor In the cross-sectional analysis of the National Health and Nutrition Examination Survey data comparing 159 children treated with stimulants for attention-deficit/hyperactivity disorder with 6330 control children, Feuer et al1 found that lower bone mass and bone density was associated with stimulant use and postulated that stimulants lower bone mass by modulating β-adrenergic signaling to osteoblasts to stimulate bone resorption and suppression bone formation.1 However, stimulant treatment has also been associated with reduced growth velocities and weight loss,2 and there was a significant discrepancy in weight between the 2 groups, with children using stimulants having lower weight, as well as lower weight for age, compared with their nonstimulant counterparts. Given that weight is a major determinant of bone mineral density and mediates its effect via loading of weight-bearing bones,3 this could potentially account for the difference in bone mass with stimulant treatment. We therefore suggest that the actual weight is likely to be of far greater relevance to include in the analysis than age or growth parameters corrected for age (ie, height and weight z scores). While it is important to be aware of the adverse effects of stimulant medication, these should not be artifactually exaggerated. We urge the authors to repeat their multivariate linear analysis using actual weights instead of age and z scores. This may establish whether the lower bone density in children using stimulants could in fact not be pathological as the authors appear to suggest but actually be appropriate for their weight. Back to top Article Information Corresponding Author: Karen N. W. Lee, MBBS, Nepean Hospital, PO Box 63, Penrith, New South Wales 2751, Australia (klee5298@uni.sydney.edu.au). Published Online: March 27, 2017. doi:10.1001/jamapediatrics.2017.0180 Conflict of Interest Disclosures: Dr Poulton reports personal fees and nonfinancial support from Shire outside the submitted work and shares in GSK. No other disclosures are reported. References 1. Feuer AJ, Thai A, Demmer RT, Vogiatzi M. Association of stimulant medication use with bone mass in children and adolescents with attention-deficit/hyperactivity disorder. JAMA Pediatr. 2016;170(12):e162804. doi:10.1001/jamapediatrics.2016.2804PubMedGoogle ScholarCrossref 2. Swanson J, Greenhill L, Wigal T, et al. Stimulant-related reductions of growth rates in the PATS. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1304-1313.PubMedGoogle ScholarCrossref 3. Boot AM, de Ridder MA, Pols HA, Krenning EP, de Muinck Keizer-Schrama SM. Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab. 1997;82(1):57-62.PubMedGoogle Scholar

Journal

JAMA PediatricsAmerican Medical Association

Published: May 1, 2017

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