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Carucci S, Zuddas A, Lampis A, Man KKC, Balia C, Buitelaar J, Danckaerts M, Dittmann RW, Donno F, Falissard B, Gagliano A, Garas P, Häge A, Hollis C, Inglis SK, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Wong ICK, Banaschewski T, Coghill D. The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents: Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project. J Atten Disord 2024; 28:722-739. [PMID: 38366816 DOI: 10.1177/10870547241226726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age. METHOD Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age. RESULTS The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable. CONCLUSION Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.
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Affiliation(s)
- Sara Carucci
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | | | | | - Kenneth K C Man
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
| | - Carla Balia
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Kerstin Konrad
- University Hospital RWTH Aachen, Germany
- RWTH Aachen and Research Centre Jülich, Germany
| | | | | | | | | | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | | | | | - Ian C K Wong
- University College London, UK
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
- Aston University, Birmingham, UK
| | | | - David Coghill
- University of Dundee, UK
- University of Melbourne, VIC, Australia
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Burns C, Michelogiannakis D, Ahmed ZU, Rossouw PE, Javed F. Influence of psychostimulants on bone mineral density and content among children with attention deficit hyperactivity disorder. A systematic review. Bone 2024; 179:116982. [PMID: 38006907 DOI: 10.1016/j.bone.2023.116982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 11/27/2023]
Abstract
There is a controversy over the influence of psychostimulant medications on bone mineral density (BMD) and bone mineral content (BMC) among children with attention-deficit-hyperactivity-disorder (ADHD). The aim of the present systematic review was to assess the influence of psychostimulant medications on BMD and BMC among children with ADHD. A comprehensive search of electronic databases, including PubMed, Scopus, Embase, and Cochrane Library, was conducted to identify relevant studies published up until July 2023. Clinical studies that addressed the focused question "Do psychostimulant medications affect bone mineral density and content in children with ADHD?" were included. Letters to the Editor, studies on animal-models, ex-vivo and in-vitro studies, commentaries and reviews were excluded. The primary outcome measures were changes in BMD and BMC. Study quality was assessed using the risk of bias for non-randomized studies-exposure tool. Five non-randomized clinical studies were included. The number of participants ranged from 18 to 6489 with mean ages ranging from 7.3 to 13.75 years. The study durations ranged between five and seven years. In all studies osseous evaluation was done using dual-energy X-ray absorptiometry. The bone locations examined included total body, lumbar-spine, femur, femoral-neck, femoral body, and pelvis. Two studies reported that psychostimulant medications reduce BMC and BMD. In one study, bone turnover, serum leptin and fat levels were reduced in children using psychostimulant medications but no unusual reduction recorded among controls. In general, 80 % of the studies concluded that psychostimulant medications compromise BMC and BMD. Power analysis was done in one study. One study had a low RoB and the remaining demonstrated some concerns. Given the methodological concerns observed in the included studies, arriving at a definitive conclusion regarding the effects of psychostimulant medications on BMC, BMD, and bone turnover in children with ADHD is challenging. However, it is important to acknowledge that an association between psychostimulant medications and these bone-related parameters cannot be disregarded.
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Affiliation(s)
- Christopher Burns
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY, United States
| | - Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY, United States
| | - Zain Uddin Ahmed
- Department of Community Dentistry & Oral Disease Prevention, Eastman Institute for Oral Health, University of Rochester, NY, United States
| | - P Emile Rossouw
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY, United States
| | - Fawad Javed
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, NY, United States.
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Say GN, Önger ME, Say F, Yontar O, Yapıcı O. Effects of methylphenidate on femoral bone growth in male rats. Hum Exp Toxicol 2023; 42:9603271231210970. [PMID: 37903444 DOI: 10.1177/09603271231210970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
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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Affiliation(s)
- Gökçe Nur Say
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Mehmet Emin Önger
- Department of Histology and Embryology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ferhat Say
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Onur Yontar
- Department of Mechanical Engineering, Faculty of Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Oktay Yapıcı
- Department of Nuclear Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Kostiner H, Kats L, Kot-Limon N, Dolev E, Blumer S. Possible Association between Methylphenidate and Mandibular Bone Characteristics Detected by Dental Panoramic Radiograph in Children and Adolescents with ADHD. CHILDREN 2022; 9:children9091276. [PMID: 36138585 PMCID: PMC9497813 DOI: 10.3390/children9091276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022]
Abstract
Some studies have shown that children treated with psychostimulants for attention-deficit hyperactivity disorder (ADHD) have decreased bone mineral density (BMD). Mandibular cortical width (MCW) may be used as a surrogate measure for evaluating BMD. We compared the MCW measured on digital panoramic radiographs (DPR) of 38 children and adolescents with ADHD who were treated with methylphenidate for at least 12 months to the MCW of 58 children and adolescents without ADHD (control). The two groups had a similar mean age (p = 0.3). Mean MCW was significantly lower among children with ADHD compared to those in the control group (2.77 ± 0.33 mm vs. 3.04 ± 0.46 mm, p = 0.004). Additionally, each of the MCW sides were significantly smaller in the group with ADHD compared with the control group. In conclusion, treatment with methylphenidate is associated with low MCW in children and adolescents with ADHD. Analysis of MCW on DPR may help in screening children that are at risk of bone health alterations that may result in low BMD in adulthood. Dentists may be the first to identify bone health abnormalities and should be aware of their role in referring their patients to further follow-up.
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Affiliation(s)
- Hadas Kostiner
- Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lazar Kats
- Department of Oral Pathology, Oral Medicine and Maxillofacial Radiology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nurit Kot-Limon
- Department of Endodontics, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91905, Israel
| | - Eran Dolev
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sigalit Blumer
- Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-6409254
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Altun Varmiş D, Yapça Kaypakli G, Yolga Tahiroğlu A, Avci A, Gül Çelik G, Metin Ö, Matyar S, Öztürk ÖG. Role of calcium metabolism in ADHD: The relationship between parathyroid hormone and ADHD symptom severity. Indian J Psychiatry 2022; 64:257-263. [PMID: 35859547 PMCID: PMC9290411 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_484_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vitamin D has been found to be associated with the pathogenesis of attention deficit hyperactivity disorder (ADHD). However, the potential role of parathyroid hormone (PTH) is still unclear. AIM We aimed to investigate the association between calcium metabolism and ADHD symptomatology. METHODS We included 106 participants aged between 7 and 13 years old (51 ADHD patients, mean age: 9.54 ± 1.77, 55 healthy controls mean age: 9.97 ± 0.94) to this study. K-SADS-PL and Conners' Parent/Teacher Rating Scales, Stroop Test were performed. Blood samples to measure serum levels of Vitamin D, PTH, calcium (Ca), magnesium (Mg), phosphorus (P), and alkaline phosphatase (ALP) were collected in the spring (March-April-May) to prevent seasonal variability. RESULTS PTH, P, and ALP values were significantly lower and Vitamin D, Ca, and Mg values were significantly higher in the ADHD group (P < 0.05, for all). Both groups had Vitamin D deficiency. Control group has lower Vitamin D levels than the ADHD group (respectively; 17.66 ± 9.07, 21.99 ± 10.99, P < 0.05). There was a negative correlation between PTH and CTRS hyperactivity, CGI-RI and CGI-EL sub-scores, CGI-Total, DSM-IV-Inattention, DSM-IV Hyperactivity/Impulsivity, DSM-IV-Total scores (P < 0.05, for all). CONCLUSIONS We found lower PTH levels in ADHD patients and a strong and negative correlation between PTH and symptom severity. Future studies are needed to clarify if these findings are due to the key role of PTH in ADHD pathology or PTH's function in activating vitamin D.
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Affiliation(s)
- Dilek Altun Varmiş
- Department of Child and Adolescent Psychiatry, Adana Ekrem Tok Mental Health Hospital, Adana, Turkey
| | - Gamze Yapça Kaypakli
- Department of Child and Adolescent Psychiatry, Hatay State Hospital, Hatay, Turkey
| | - Ayşegül Yolga Tahiroğlu
- Department of Child and Adolescent Psychiatry, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Ayse Avci
- Department of Child and Adolescent Psychiatry, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Gonca Gül Çelik
- Department of Child and Adolescent Psychiatry, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Özge Metin
- Department of Child and Adolescent Psychiatry, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Selcuk Matyar
- Department of Biochemistry, Cukurova University, Faculty of Medicine, Adana, Turkey
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Fu Y, Wang G, Liu J, Li M, Dong M, Zhang C, Xu R, Liu X. Stimulant use and bone health in US children and adolescents: analysis of the NHANES data. Eur J Pediatr 2022; 181:1633-1642. [PMID: 35091797 DOI: 10.1007/s00431-021-04356-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
Abstract
UNLABELLED Stimulants have become the most popular psychopharmacologic drugs used in therapy for attention-deficit/hyperactivity disorder (ADHD). Childhood and adolescence are crucial periods for optimizing bone health to prevent osteoporosis-related fractures in old age. However, controversy remains regarding the relationship between stimulant use and bone health. The present study was designed to examine the bone mineral content (BMC) and bone mineral density (BMD) of 5472 individuals aged 8-16 years with or without stimulant use based on National Health and Nutrition Examination Survey (NHANES) 2011-2018 data and to further assess the association between stimulant use and bone health. Among these, 284 (5.2%) participants were using stimulants. In analyses stratified by sex, the BMC and BMD at the level of the lumbar spine, pelvis, and total body were generally lower among stimulant users than among nonusers in males (all P < 0.001), while the differences were not statistically significant in females. In multivariable linear regression models, the increasing range of BMCs and BMDs with age was lower in participants using stimulants than in those not using stimulants after fully adjusting for potential confounding factors. Compared to participants not using stimulants, stimulant use ≥ 3 months was associated with significantly lower BMCs [lumbar spine: β = - 1.35, (95% CI: - 2.56, - 0.14); pelvis: β = - 9.06, (95% CI: - 15.21, - 2.91); and total: β = - 52.96, (95% CI: - 85.87, - 20.04)] and BMDs [pelvis: β = - 0.03, (95% CI: - 0.04, - 0.01), total: β = - 0.01, (95% CI: - 0.02, - 0.00)]. CONCLUSIONS Children and adolescents using stimulants exhibited reductions in BMC and BMD at the lumbar spine, pelvis, and total body compared to those who were not using stimulants, especially among males. WHAT IS KNOWN • Childhood and adolescence are crucial periods for optimizing bone health to prevent osteoporosis-related fractures in old age. • Controversy remains regarding the relationship between stimulant use and bone health. WHAT IS NEW • The bone mineral content and bone mineral density at the level of the lumbar spine, pelvis, and total body were generally lower among stimulant users than among nonusers in males, while the differences were not statistically significant in females. • Body mass index and serum alkaline phosphatase may be predictors for loss of bone mineral content and bone mineral density in stimulant users.
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Affiliation(s)
- Yanan Fu
- Department of Medical Engineering, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Guan Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China.,NHC Key Laboratory of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Junhui Liu
- School of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Meng Li
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Meng Dong
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Chen Zhang
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Rui Xu
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Xinjie Liu
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China.
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Dursun S, Sezen Erhamza T, Önder ME, Erdoğan Düzcü S. Effect of methylphenidate at different doses on new bone formation with rapid maxillary expansion: A micro-CT and histomorphometric study in rats. Orthod Craniofac Res 2021; 25:384-392. [PMID: 34821040 DOI: 10.1111/ocr.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/06/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effect of systemically administered methylphenidate hydrochloride (MPH) on new bone formation in premaxillary suture after rapid maxillary expansion (RME). SETTING AND SAMPLE POPULATION Thirty-three Wistar rats were divided into four groups: Group 1 (high dose, 30/60 mg/kg MPH), Group 2 (low dose, 4/10 mg/kg MPH), Group 3 (positive control) and Group 4 (negative control). METHODS RME was applied on the 70th day of the study. A 5-day RME period was followed by a 12-day retention period. The experiment was terminated on the 87th day. Micro-CT for radiological evaluation, haematoxylin-eosin and Masson's trichrome staining methods were used for histomorphometric evaluation. RESULTS Among experimental groups with RME, the lowest number of osteoblasts and capillaries in Group 1 (P < .05). New bone formation, fibrous callus formation, distal osteotomy line, proximal osteotomy union and cortex remodelling were observed to be lower in Group 1 and Group 2 than Group 3 (P < .05). There was a statistically significant difference between Group 4 and each of the other groups (P = .000) in the evaluation of the results for bone mineral density, bone volume, bone volume percentage, trabecular thickness and trabecular number. CONCLUSIONS MPH reduces cellular activity for new bone formation in suture in RME groups. Before performing rapid maxillary expansion in patients using MPH, the use of the drug should be postponed after a multidisciplinary decision process or clinical doses should be lowered.
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Affiliation(s)
- S Dursun
- Academic Department of Oral and Dental Health, Faculty of Dentistry, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - T Sezen Erhamza
- Department of Orthodontics, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - M E Önder
- Department of Dentomaxillofacial Surgery, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - S Erdoğan Düzcü
- Department of Medical Pathology, Faculty of Medicine, Bolu Abant İzzet Baysal University, Bolu, Turkey
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Çevikaslan A, Parlak M, Ellidağ HY, Kulaksızoğlu SÇ, Yılmaz N. Effects of methylphenidate on height, weight and blood biochemistry parameters in prepubertal boys with attention deficit hyperactivity disorder: an open label prospective study. Scand J Child Adolesc Psychiatr Psychol 2021; 9:163-173. [PMID: 34549033 PMCID: PMC8436573 DOI: 10.21307/sjcapp-2021-018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 08/17/2021] [Indexed: 11/11/2022] Open
Abstract
Background: Adverse effects of stimulants on growth in children have long been studied, but the results remain to be clarified, because metabolic changes or predictors accompanying the growth deviations were not sufficiently studied. Objective: This open label-prospective study investigated the effects of methylphenidate (MPH) on weight, height, blood biochemistry in children with attention deficit hyperactivity disorder (ADHD). Method: Prepubertal boys treated with MPH in Child and Adolescent Psychiatry Clinic at Antalya Training and Research Hospital in Health Sciences University, Turkey were recruited. Height and weight z-scores and fasting blood samples were taken at baseline and 6th month. Changes were compared by paired-samples t-test or Wilcoxon signed-rank test. Any association between the changes in growth and biochemical values was analyzed by Spearman's Rank-Order Correlation. The statistical significance threshold was p<0.01. Results: 31 boys aged 74 to 104 months were enrolled in the study sample (mean=87.6, Standard Deviation (SD)=9.2). Osmotic release oral system-MPH (18 mg/day) was used in 77.4% (N=24) and immediate release-MPH (5 mg three times a day) in 22.5% (N=7). Average daily drug dose was 0.66 mg/kg (SD=0.12). Baseline weight z-score was 0.63 (SD=1.12), decreased significantly at 6 months (0.24 [SD=1.04]) (Z=-4.44, p=0.000, r=0.5) (median z-score was 0.53 at baseline, -0.11 at 6 months). Baseline height z-score (0.23[SD=0.87]) was not suppressed significantly at 6 months (0.28[SD=0.85])(t(30) = ‒1.50, p=0.14). Glucose (t(30) = -4.33, p=0.000, r=0.6), creatinine (t(30)=-3.28, p=0.003, r=0.5) and 25OH-VitD (N=29, Z=-3.98, p=0.000, r=0.5) increased but alkaline phosphatase (ALP) decreased (t(28)=3.63, p=0.001, r=0.5). The differences in W-SDS and ALP were positively correlated (r=0.47, p=0.009). Conclusions: Our results indicate the importance of monitoring blood variables that may accompany growth changes early in MPH treatment and should be further assessed in larger samples.
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Affiliation(s)
- Ahmet Çevikaslan
- Child and Adolescent Psychiatry Clinic, Antalya Training and Research Hospital, Turkey
| | - Mesut Parlak
- Pediatric Endocrinology Division, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hamit Yaşar Ellidağ
- Clinical Biochemistry Division, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Necat Yılmaz
- Clinical Biochemistry Division, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
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ADHD, stimulant medication use, and the risk of fracture: a systematic review and meta-analysis. Arch Osteoporos 2021; 16:81. [PMID: 34076749 DOI: 10.1007/s11657-021-00960-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We performed a meta-analysis to quantify the relationships among a diagnosis of attention-deficit/hyperactivity disorder (ADHD), the use of stimulant medication, and the risk of fracture. There was a significant positive association between ADHD and the risk of fracture. However, stimulant ADHD medication therapy appears to be associated with a reduced risk of fracture in patients with ADHD. INTRODUCTION ADHD is associated with an increased fracture risk due to a lack of impulse control. ADHD medication may have a protective effect via behavior modification. However, previous research found an adverse effect of stimulant use on bone mass. Therefore, this meta-analysis study assessed the relationships among ADHD, the use of stimulant medication, and fracture risk. METHODS A literature search was conducted using PubMed and EMBASE from inception through December 2020. Random-effects models were used to determine overall pooled estimates and 95% confidence intervals (CIs). RESULTS The meta-analysis included 10 observational studies. Our results showed that ADHD diagnosis is associated with an increased risk of fracture (OR = 1.17; 1.01-1.35, p = 0.035). Notably, a higher risk of fracture (OR = 1.37, 95% CI 1.2-1.58, p < 0.001) was observed in non-stimulant-treated ADHD. However, no significant association, but a trend toward a lower risk, was observed for stimulant-treated ADHD patients compared with non-stimulant-treated ADHD patients (OR = 0.7, 95% CI 0.47-1.03, p = 0.073). In terms of fracture type, non-stimulant-treated ADHD was associated with traumatic fracture (OR = 1.79, 95% CI 1.54-2.08, p < 0.001) or stress fracture (OR = 1.12, 95% CI 1.04-1.2, p = 0.004) compared to healthy control (HC). In addition, further findings from our systematic review showed that the risk of traumatic (OR = 1, 95% CI 0.88-1.13, p = 0.954) or stress (OR = 0.84, 95% CI 0.62-1.14, p = 0.256) fracture was comparable between treated stimulant-ADHD patients and HC. CONCLUSIONS Individuals with ADHD are at higher risk of fracture than the general population. Stimulant ADHD medication appears to be associated with a lower risk of traumatic fracture but not with a higher risk of stress fracture.
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Carucci S, Balia C, Gagliano A, Lampis A, Buitelaar JK, Danckaerts M, Dittmann RW, Garas P, Hollis C, Inglis S, Konrad K, Kovshoff H, Liddle EB, McCarthy S, Nagy P, Panei P, Romaniello R, Usala T, Wong ICK, Banaschewski T, Sonuga-Barke E, Coghill D, Zuddas A. Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 120:509-525. [PMID: 33080250 DOI: 10.1016/j.neubiorev.2020.09.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/11/2020] [Accepted: 09/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Methylphenidate (MPH) is an efficacious treatment for ADHD but concerns have been raised about potential adverse effects of extended treatment on growth. OBJECTIVES To systematically review the literature, up to December 2018, conducting a meta-analysis of association of long-term (> six months) MPH exposure with height, weight and timing of puberty. RESULTS Eighteen studies (ADHD n = 4868) were included in the meta-analysis. MPH was associated with consistent statistically significant pre-post difference for both height (SMD = 0.27, 95% CI 0.16-0.38, p < 0.0001) and weight (SMD = 0.33, 95% CI 0.22-0.44, p < 0.0001) Z scores, with prominent impact on weight during the first 12 months and on height within the first 24-30 months. No significant effects of dose, formulation, age and drug-naïve condition as clinical moderators were found. Data on timing of puberty are currently limited. CONCLUSIONS Long-term treatment with MPH can result in reduction in height and weight. However, effect sizes are small with possible minimal clinical impact. Long-term prospective studies may help to clarify the underlying biological drivers and specific mediators and moderators.
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Affiliation(s)
- Sara Carucci
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy.
| | - Carla Balia
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Antonella Gagliano
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
| | - Angelico Lampis
- Paediatric Endocrinology Unit, A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Garas
- Semmelweis University Mental Health Sciences School of PhD Studies, Budapest, Hungary
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sarah Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, RWTH Aachen University, Aachen, Germany; JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Pietro Panei
- Grant Office and Technology Transfer, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Romaniello
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Tatiana Usala
- Child and Adolescent Neuropsychiatry Unit, Azienda per la Tutela della Salute, ATS Sardegna, ASSL Oristano, Italy
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tobias Banaschewski
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Alessandro Zuddas
- Department of Biomedical Sciences, Section Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry, "A. Cao'' Paediatric Hospital, "G. Brotzu" Hospital Trust, Via E. Jenner, 09121 Cagliari, Italy
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Abstract
It is from the discovery of leptin and the central nervous system as a regulator of bone remodeling that the presence of autonomic nerves within the skeleton transitioned from a mere histological observation to the mechanism whereby neurons of the central nervous system communicate with cells of the bone microenvironment and regulate bone homeostasis. This shift in paradigm sparked new preclinical and clinical investigations aimed at defining the contribution of sympathetic, parasympathetic, and sensory nerves to the process of bone development, bone mass accrual, bone remodeling, and cancer metastasis. The aim of this article is to review the data that led to the current understanding of the interactions between the autonomic and skeletal systems and to present a critical appraisal of the literature, bringing forth a schema that can put into physiological and clinical context the main genetic and pharmacological observations pointing to the existence of an autonomic control of skeletal homeostasis. The different types of nerves found in the skeleton, their functional interactions with bone cells, their impact on bone development, bone mass accrual and remodeling, and the possible clinical or pathophysiological relevance of these findings are discussed.
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Affiliation(s)
- Florent Elefteriou
- Department of Molecular and Human Genetics and Orthopedic Surgery, Center for Skeletal Medicine and Biology, Baylor College of Medicine , Houston, Texas
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12
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Schermann H, Gurel R, Ankory R, Kadar A, Yoffe V, Snir N, Sternheim A, Karakis I. Lower risk of fractures under methylphenidate treatment for ADHD: A dose-response effect. J Orthop Res 2018; 36:3328-3333. [PMID: 30129682 DOI: 10.1002/jor.24129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/03/2018] [Indexed: 02/04/2023]
Abstract
Methylphenidate (MP), a widely used and abused stimulant medication for ADHD, negatively affects bone mass. However, previous epidemiological studies demonstrated that MP is not associated with increased incidence of fractures in children, and may even have a protective effect due to behavior modification. This study aimed to investigate the association between MP and fracture risk in a retrospective cohort of healthy military recruits, aged 18-25, with at least 1 year of service between 2008 and 2017. Subjects were divided into five groups: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1-90, 91-180, or 181+ tablets during the study period. The primary outcome was at least one fracture diagnosis during the study. Among 682,110 subjects (409,175 men [60%]), 50,999 (7.5%) had fractures. MP was used by 1,681 (0.4%) men and 2.828 (1%) women. The fracture rates in the no ADHD, untreated ADHD, ADHD 0-90, ADHD 91-180, and ADHD 181+ groups were 10.4%, 16.4%, 8.7%, 4.8% and 5.8% in men, and 3.6%, 7.1%, 4.6%, 4.4% and 3% in women, respectively. Multivariate regression analysis confirmed an inverse dose-response association between MP and fractures in men (p < 0.001). In women, untreated ADHD was associated with a significantly higher fracture risk, compared to healthy controls (OR = 1.82, p < 0.001). The study confirms previous literature and demonstrates an inverse dose-response association between MP and fracture risk in men. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3328-3333, 2018.
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Affiliation(s)
- Haggai Schermann
- Divison of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Weizmann 6, Tel Aviv, Israel
| | - Ron Gurel
- Divison of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Weizmann 6, Tel Aviv, Israel
| | - Ran Ankory
- Divison of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Weizmann 6, Tel Aviv, Israel
| | - Assaf Kadar
- Divison of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Weizmann 6, Tel Aviv, Israel
| | - Victoria Yoffe
- Divison of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Weizmann 6, Tel Aviv, Israel
| | - Nimrod Snir
- Divison of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Weizmann 6, Tel Aviv, Israel
| | - Amir Sternheim
- National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Isabella Karakis
- Environmental Epidemiology Department, Public Health Services, Ministry of Health, Israel.,Ashkelon Academic College, Ashkelon, Israel
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13
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Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira‐Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Gluud C. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies. Cochrane Database Syst Rev 2018; 5:CD012069. [PMID: 29744873 PMCID: PMC6494554 DOI: 10.1002/14651858.cd012069.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. The psychostimulant methylphenidate is the most frequently used medication to treat it. Several studies have investigated the benefits of methylphenidate, showing possible favourable effects on ADHD symptoms, but the true magnitude of the effect is unknown. Concerning adverse events associated with the treatment, our systematic review of randomised clinical trials (RCTs) demonstrated no increase in serious adverse events, but a high proportion of participants suffered a range of non-serious adverse events. OBJECTIVES To assess the adverse events associated with methylphenidate treatment for children and adolescents with ADHD in non-randomised studies. SEARCH METHODS In January 2016, we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 12 other databases and two trials registers. We also checked reference lists and contacted authors and pharmaceutical companies to identify additional studies. SELECTION CRITERIA We included non-randomised study designs. These comprised comparative and non-comparative cohort studies, patient-control studies, patient reports/series and cross-sectional studies of methylphenidate administered at any dosage or formulation. We also included methylphenidate groups from RCTs assessing methylphenidate versus other interventions for ADHD as well as data from follow-up periods in RCTs. Participants had to have an ADHD diagnosis (from the 3rd to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or the 9th or 10th edition of theInternational Classification of Diseases, with or without comorbid diagnoses. We required that at least 75% of participants had a normal intellectual capacity (intelligence quotient of more than 70 points) and were aged below 20 years. We excluded studies that used another ADHD drug as a co-intervention. DATA COLLECTION AND ANALYSIS Fourteen review authors selected studies independently. Two review authors assessed risk of bias independently using the ROBINS-I tool for assessing risk of bias in non-randomised studies of interventions. All review authors extracted data. We defined serious adverse events according to the International Committee of Harmonization as any lethal, life-threatening or life-changing event. We considered all other adverse events to be non-serious adverse events and conducted meta-analyses of data from comparative studies. We calculated meta-analytic estimates of prevalence from non-comparative cohorts studies and synthesised data from patient reports/series qualitatively. We investigated heterogeneity by conducting subgroup analyses, and we also conducted sensitivity analyses. MAIN RESULTS We included a total of 260 studies: 7 comparative cohort studies, 6 of which compared 968 patients who were exposed to methylphenidate to 166 controls, and 1 which assessed 1224 patients that were exposed or not exposed to methylphenidate during different time periods; 4 patient-control studies (53,192 exposed to methylphenidate and 19,906 controls); 177 non-comparative cohort studies (2,207,751 participants); 2 cross-sectional studies (96 participants) and 70 patient reports/series (206 participants). Participants' ages ranged from 3 years to 20 years. Risk of bias in the included comparative studies ranged from moderate to critical, with most studies showing critical risk of bias. We evaluated all non-comparative studies at critical risk of bias. The GRADE quality rating of the evidence was very low.Primary outcomesIn the comparative studies, methylphenidate increased the risk ratio (RR) of serious adverse events (RR 1.36, 95% confidence interval (CI) 1.17 to 1.57; 2 studies, 72,005 participants); any psychotic disorder (RR 1.36, 95% CI 1.17 to 1.57; 1 study, 71,771 participants); and arrhythmia (RR 1.61, 95% CI 1.48 to 1.74; 1 study, 1224 participants) compared to no intervention.In the non-comparative cohort studies, the proportion of participants on methylphenidate experiencing any serious adverse event was 1.20% (95% CI 0.70% to 2.00%; 50 studies, 162,422 participants). Withdrawal from methylphenidate due to any serious adverse events occurred in 1.20% (95% CI 0.60% to 2.30%; 7 studies, 1173 participants) and adverse events of unknown severity led to withdrawal in 7.30% of participants (95% CI 5.30% to 10.0%; 22 studies, 3708 participants).Secondary outcomesIn the comparative studies, methylphenidate, compared to no intervention, increased the RR of insomnia and sleep problems (RR 2.58, 95% CI 1.24 to 5.34; 3 studies, 425 participants) and decreased appetite (RR 15.06, 95% CI 2.12 to 106.83; 1 study, 335 participants).With non-comparative cohort studies, the proportion of participants on methylphenidate with any non-serious adverse events was 51.2% (95% CI 41.2% to 61.1%; 49 studies, 13,978 participants). These included difficulty falling asleep, 17.9% (95% CI 14.7% to 21.6%; 82 studies, 11,507 participants); headache, 14.4% (95% CI 11.3% to 18.3%; 90 studies, 13,469 participants); abdominal pain, 10.7% (95% CI 8.60% to 13.3%; 79 studies, 11,750 participants); and decreased appetite, 31.1% (95% CI 26.5% to 36.2%; 84 studies, 11,594 participants). Withdrawal of methylphenidate due to non-serious adverse events occurred in 6.20% (95% CI 4.80% to 7.90%; 37 studies, 7142 participants), and 16.2% were withdrawn for unknown reasons (95% CI 13.0% to 19.9%; 57 studies, 8340 participants). AUTHORS' CONCLUSIONS Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate. Our certainty in the evidence is very low, and accordingly, it is not possible to accurately estimate the actual risk of adverse events. It might be higher than reported here.Given the possible association between methylphenidate and the adverse events identified, it may be important to identify people who are most susceptible to adverse events. To do this we must undertake large-scale, high-quality RCTs, along with studies aimed at identifying responders and non-responders.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Nadia Pedersen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | - Helle B Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | | | | | - Trine Gerner
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Maria Skoog
- Clinical Studies Sweden ‐ Forum SouthClinical Study SupportLundSweden
| | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Centre for Evidence‐Informed Healthcare and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreIndia632002
| | - Sasja J Håkonsen
- Aalborg UniversityDepartment of Health Science and TechnologyNiels Jernes Vej 14AalborgDenmark9220
| | | | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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Bone Health, Attention-deficit Hyperactivity Disorder, and the Role of Psychostimulant Abuse: A Reply to Howard et al (2015). J Pediatr Orthop 2018; 38:e27-e28. [PMID: 28141688 DOI: 10.1097/bpo.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Preliminary Evidence of an Association Between ADHD Medications and Diminished Bone Health in Children and Adolescents. J Pediatr Orthop 2017; 37:348-354. [PMID: 26398435 DOI: 10.1097/bpo.0000000000000651] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The US Centers for Disease Control and Prevention estimate that 3.5 million children use psychotropic drugs for attention-deficit hyperactivity disorder (ADHD). With an increase in use of these types of drugs, thorough understanding of their potential side effects on the growing skeleton is needed. The purpose of this study was to determine whether there is an association between use of ADHD medication and diminished bone health. METHODS Three waves of the National Health and Nutrition Examination Survey public-use data set, collected from 2005 through 2010, were compiled for this study (N=5315). Bone health was measured using dual-energy x-ray absorptiometry scans, which were performed for participants aged 8 to 17 years to determine bone mineral density (BMD) for 3 regions: (1) total femur; (2) femoral neck; and (3) lumbar. Use of ADHD medications was determined by self-reported responses to questions regarding prescription drug use, which were answered by either the respondent or the respondent's parent or guardian. Multiple statistical techniques were used to produce estimates of association between ADHD medication use and z score age and sex standardized BMD measures, including survey adjusted univariate, survey adjusted multiple linear regression, and generalized estimating equations with a propensity-matched subsample (N=1967). Multivariate models adjusted for covariates including time period, age, sex, race/ethnicity, family income to poverty ratio, and total number of prescription medications. RESULTS Conservative estimates of the difference in standardized BMD measures between the ADHD medication group and the nonmedicated group range from -0.4855 (±0.27; P<0.001) for total femoral, -0.4671 (±0.27; P<0.001) for femoral neck, and -0.3947 (±0.29; P<0.01) for lumbar. Significantly more children on ADHD medications versus match subjects on no medication had BMDs with in osteopenic range (38.3% vs. 21.6%, P<0.01). DISCUSSION The findings suggest that there are real and nontrivial differences in BMD for children and adolescents taking ADHD medications, as compared with similar children not taking any prescription medications. Prescribing physicians and parents should be aware of potential bone health risks associated with these medications. LEVEL OF EVIDENCE Level III-case-control study.
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16
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Aghili H, Yassaei S, Zahir ST, Arjmandi R. Effect of Methylphenidate on Orthodontic Tooth Movement and Histological Features of Bone Tissue in Rats: An Experimental Study. J Clin Diagn Res 2017; 11:ZF01-ZF05. [PMID: 28893054 DOI: 10.7860/jcdr/2017/26217.10169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Methylphenidate is a psychostimulant drug, which is commonly used by children and teenagers. This age group receives most orthodontic treatment. Effect of this drug on tooth movement is unknown. AIM The aim of this study was to evaluate the effect of methylphenidate on orthodontic tooth movement and histological features of bone tissue in rats. MATERIALS AND METHODS Forty-two Wistar rats (male) were selected and divided to three groups, randomly (n=14). The control group (Group 1) received no drug, the experimental Group 2 received a constant dose of methylphenidate daily for 14 days while the experimental Group 3 received increasing doses of methylphenidate daily. To exert force, a NiTi coil spring was placed between the maxillary right first molar and the maxillary right central incisor. At the end of the study period, the amount of tooth movement was measured and then the rats were sacrificed for histological analysis of bone tissue. Differences between the experimental groups were analysed using Kruskal-wallis and Mann-Whitney U tests. RESULTS No significant differences were found in the amount of orthodontic tooth movement or osteoclasts and lacunae, between the experimental groups (p>0.05). Mann-Whitney U analysis showed significant differences in the depth of resorption lacuna between Group 2 and 3 (p=0.037). CONCLUSION Methylphenidate has no significant effect on orthodontic tooth movement or histological features of bone tissue in rats.
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Affiliation(s)
- Hossein Aghili
- Assosiate Professor, Department of Orthodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Soghra Yassaei
- Professor, Department of Orthodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Shokouh Taghipour Zahir
- Professor, Department of Clinical Pathology, Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Rahele Arjmandi
- Postgraduate Student, Department of Orthodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Jacob L, Kostev K. Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices. Osteoporos Int 2017; 28:1265-1269. [PMID: 27882412 DOI: 10.1007/s00198-016-3842-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/11/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED Two thousand eight hundred ninety-four children and adolescents treated by 243 pediatricians were analyzed. Patients receiving attention deficit hyperactivity disorder (ADHD) medications were at a lower risk of fractures than patients without ADHD medications. The strongest impact was in the age group of 6-9 years. Finally, there was a significant association between therapy duration and fracture risk. INTRODUCTION The aim of this study was to analyze the impact of ADHD therapy on fracture risk in children treated by German pediatricians. METHODS Children and adolescents initially diagnosed with ADHD and fractures between 2010 and 2015 were identified by 243 pediatricians. In this nested case-control study, each ADHD case with a fracture was matched (1:1) to an ADHD control without a fracture for age, gender, index year, and physician. In total, 2894 individuals were available for analysis. The main outcome of the study was the risk of fracture as a function of ADHD therapy. Multivariate logistic regression models were created to determine the effect of ADHD therapy on the risk of fracture in the entire population and in three age-specific subgroups. RESULTS Patients receiving ADHD medications were at a lower risk of fracture than patients without ADHD medications (OR = 0.61). The impact of ADHD therapy on the risk of fracture was stronger in the age group of 6-9 years (OR = 0.41) than in the age groups of 10-13 years (OR = 0.68) and 14-17 years (OR = 0.74). Finally, a significant correlation was found between therapy duration and fracture risk (OR = 0.71 per month). CONCLUSION ADHD therapy was associated with a decrease in the risk of fracture in children and adolescents treated by German pediatricians.
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Affiliation(s)
- L Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | - K Kostev
- Department of Epidemiology, IMS Health, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany.
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Perry BA, Archer KR, Song Y, Ma Y, Green JK, Elefteriou F, Dahir KM. Medication therapy for attention deficit/hyperactivity disorder is associated with lower risk of fracture: a retrospective cohort study. Osteoporos Int 2016; 27:2223-2227. [PMID: 26928186 DOI: 10.1007/s00198-016-3547-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/17/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED The impact of pharmacotherapy for attention deficit/hyperactivity disorder on fracture risk has not been well studied. In this retrospective cohort study, medication therapy was associated with lower fracture incidence. Further studies are needed to better characterize the short-term and long-term effects of these medications on bone health and fracture risk. INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) is associated with increased risk of bone fractures. The impact of pharmacotherapy with either stimulant or non-stimulant medications on fracture risk has not been well characterized. We performed a study to compare fracture incidence in ADHD patients treated with stimulant or non-stimulant medications vs. no pharmacotherapy. METHODS In this retrospective cohort study, data were extracted from a large electronic medical record. A total of 10,066 subjects with ADHD, 40 years or younger, were included. We extracted data regarding stimulant and non-stimulant ADHD medications, corticosteroids, fracture data, demographic data, and diabetes history. RESULTS A total of 1015 patients (10 %) sustained fractures. Multivariable Cox proportional hazard analysis indicated that compared to those with two or more prescriptions for an ADHD medication, individuals without documented medication therapy had a significantly increased hazard of fracture (hazard ratio [HR] 3.9, 95 % confidence interval [CI] 2.6-5.9). However, the hazard ratio for stimulant vs. non-stimulant medication (HR 0.92, 95 % CI 0.60-1.4) was not statistically significant. CONCLUSIONS Three times as many patients with no documented ADHD medication prescriptions suffer a fracture compared to patients with a history of two or more prescriptions for an ADHD medication. Treatment and adherence are thus important to prevent fracture in this population.
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Affiliation(s)
- B A Perry
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University, Nashville, USA
| | - K R Archer
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, USA
| | - Y Song
- Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, USA
| | - Y Ma
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, USA
| | - J K Green
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, USA
- Department of Pharmacology, Vanderbilt University, Nashville, USA
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA
| | - F Elefteriou
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University, Nashville, USA
- Department of Medicine, Vanderbilt University, Nashville, USA
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA
| | - K M Dahir
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University, Nashville, USA
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Calarge CA, Schlechte JA, Burns TL, Zemel BS. The effect of psychostimulants on skeletal health in boys co-treated with risperidone. J Pediatr 2015; 166:1449-54.e1. [PMID: 25863660 PMCID: PMC4446198 DOI: 10.1016/j.jpeds.2015.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/19/2015] [Accepted: 03/03/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To examine the skeletal effects of chronic psychostimulant treatment in children and adolescents. STUDY DESIGN Medically healthy 5- to 17-year-old males from 4 different clinic-based studies were combined for this analysis. They were divided by psychostimulant use into 3 groups: none to negligible, intermittent, and continuous use. Most (95%) had also received risperidone for 6 months or more. Treatment history was extracted from medical and pharmacy records. Anthropometric and bone measurements, using dual-energy x-ray absorptiometry and peripheral quantitative computed tomography, were obtained at each research visit. Multivariable linear regression analysis models examined whether age-sex-specific height Z-score and skeletal outcomes differed among the 3 psychostimulant-use groups. RESULTS The sample consisted of 194 males with a mean age of 11.7 ± 2.8 years at study entry. The majority had an externalizing disorder. There was no significant difference across the 3 treatment groups in height Z-score or in skeletal outcomes at the radius, lumbar spine, or whole body. One hundred forty-four boys had valid follow-up skeletal data 1.4 ± 0.7 years after study entry. Again, neither height Z-score nor the skeletal outcomes were different among those who remained on psychostimulants between the 2 visits, started psychostimulants anew, or had not taken psychostimulants. CONCLUSIONS Following chronic treatment, psychostimulants did not appear to significantly affect bone mass accrual in children and adolescents taking risperidone. There was a small, but statistically not significant, negative impact on longitudinal growth.
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Affiliation(s)
- Chadi A. Calarge
- Menninger Department of Psychiatry and Behavioral Science and Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin Street, Suite 1740, Houston, TX 77030-2399, Tel: 832-824-4764, Fax: 832-825-8981
| | - Janet A. Schlechte
- Department of Internal Medicine, The University of Iowa Carver College of Medicine
| | - Trudy L. Burns
- Department of Epidemiology, The University of Iowa College of Public Health
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Weight loss on stimulant medication: how does it affect body composition and bone metabolism? - A prospective longitudinal study. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2012; 2012:30. [PMID: 23216890 PMCID: PMC3549744 DOI: 10.1186/1687-9856-2012-30] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/30/2012] [Indexed: 01/23/2023]
Abstract
Objective Children treated with stimulant medication for attention deficit hyperactivity disorder (ADHD) often lose weight. It is important to understand the implications of this during growth. This prospective study was designed to quantify the changes in body composition and markers of bone metabolism on starting treatment. Methods 34 children (29 boys) aged 4.7 to 9.1 years newly diagnosed with ADHD were treated with dexamphetamine or methylphenidate, titrating the dose to optimise the therapeutic response. Medication was continued for as long as clinically indicated. Body composition and bone density (dual-energy X-ray absorptiometry) were measured at baseline, 6 months and 3 years; changes were analysed in Z-scores based on data from 241 healthy, local children. Markers of bone turnover were measured at baseline, 3 months and 3 years. Results Fat loss of 1.4±0.96kg (total fat 5.7±3.6 to 4.3±3.1kg, p<0.001) occurred in the first 6 months. There were significant reductions over 3 years in the sex and height corrected Z-scores for lean tissue, bone mineral content, bone mineral density and ratio of central to total fat (−0.84±0.86, p=0.003; -0.55±0.31, p<0.0001; -0.41±0.28, p<0.0001 and −0.55±0.62, p=0.006 respectively). Propeptide of type I collagen indicated a significant reduction in bone turnover after 3 months (564±202 to 458±96ng/ml, p=0.019), which was fully recovered after 3 years (619±276ng/ml). Conclusions Stimulant medication was associated with early fat loss and reduced bone turnover. Lean tissue including bone increased more slowly over 3 years of continuous treatment than would be expected for growth in height. There was long-term improvement in the proportion of central fat for height. This study shows that relatively minor reductions in weight on stimulant medication can be associated with long-term changes in body composition. Further study is required to determine the effects of these changes on adult health.
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Graham J, Coghill D. Adverse effects of pharmacotherapies for attention-deficit hyperactivity disorder: epidemiology, prevention and management. CNS Drugs 2008; 22:213-37. [PMID: 18278977 DOI: 10.2165/00023210-200822030-00003] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Medication for the treatment of attention-deficit hyperactivity disorder (ADHD) is in widespread use globally. There is considerable data suggesting that overall, the adverse effect burden from this use is dose dependent and is in the mild to moderate category, but few comprehensive reviews exist of the epidemiology of adverse effects alone. This review provides a general and systems-specific summary of the scientific literature regarding adverse effect data for the drugs in general use for the treatment of ADHD. Although several areas lack definitive data, current evidence suggests that, for the majority of those treated for ADHD, the medications currently available pose little in the way of risk of significant harm. Epidemiological data suggest a low incidence of serious adverse effects, whilst the less serious adverse effects, such as insomnia and anorexia, are relatively common. Also, some specific areas of study suggest lower risks of harm than previously thought, e.g. tic disorders and seizures. However, pre-existing conditions and other interindividual differences may raise the risk of harmful adverse effects, which adds emphasis to the need for careful pretreatment assessment and monitoring. Potential but unlikely long-term treatment effects need to be investigated as carefully as possible, particularly with regard to cardiac sequelae and carcinogenesis. There are both overlaps and differences between the adverse effects of stimulants and nonstimulants, such as atomoxetine. For example, the latter shares the stimulant group's potential for changing cardiovascular parameters, but may not cause insomnia.
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Affiliation(s)
- Johnny Graham
- Child and Adolescent Psychiatry, University of Dundee, Section of Psychiatry, Division of Pathology and Neuroscience, Ninewells Hospital, Dundee, Scotland.
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Golub M, Costa L, Crofton K, Frank D, Fried P, Gladen B, Henderson R, Liebelt E, Lusskin S, Marty S, Rowland A, Scialli J, Vore M. NTP-CERHR Expert Panel Report on the reproductive and developmental toxicity of methylphenidate. ACTA ACUST UNITED AC 2005; 74:300-81. [PMID: 16127684 DOI: 10.1002/bdrb.20049] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Mari Golub
- California Environment Protection Agency, Sacramento, California, USA
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