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Stimulant use and bone health in US children and adolescents: analysis of the NHANES data

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Abstract

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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Availability of data and material

The data used to support the findings of this study are available from the corresponding author upon request.

Abbreviations

ADHD:

Attention-deficit/hyperactivity disorder

ALP:

Alkaline phosphatase

BMC:

Bone mineral content

BMD:

Bone mineral density

BMI:

Body mass index

DA:

Dopamine

DXA:

Dual-energy X-ray absorptiometry

MEC:

Mobile examination center

NCHS:

National Center for Health Statistics

NE:

Norepinephrine

NHANES:

National Health and Nutrition Examination Survey

PIR:

Poverty income ratio

RANKL:

Receptor activator of nuclear factor κ-β (NF-κB) ligand

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Funding

This work is supported by grants from the Natural Science Foundation of Shandong Province (ZR201808010011), the Science Foundation of Qilu Hospital of Shandong University (2019QLQN28), and the National Natural Science Foundation of China (82171352).

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Author notes

  1. Yanan Fu and Guan Wang contributed equally as co-first authors.

Authors and Affiliations

  1. Department of Medical Engineering, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China

    Yanan Fu

  2. Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China

    Guan Wang, Meng Li, Meng Dong, Chen Zhang, Rui Xu & Xinjie Liu

  3. NHC Key Laboratory of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan, Shandong Province, 250012, China

    Guan Wang

  4. School of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan, Shandong Province, 250012, China

    Junhui Liu

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Contributions

YAF and GW contributed to the study conception and design, collected the data, wrote the first draft, performed the data analysis, and revised the manuscript. JHL contributed to the study conception and design and collected and analyzed the data. ML, MD, CZ, and RX contributed to the data analysis and reviewed and revised the manuscript. XJL contributed to the study conception and design, performed the data analysis, and revised the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Xinjie Liu.

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Ethics approval

The survey protocol was approved by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) Ethics Review Board, and all participants provided written informed consent.

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All participants provided written informed consent.

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Not applicable.

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The authors declare no competing interests.

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Communicated by Gregorio Paolo Milani

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Fu, Y., Wang, G., Liu, J. et al. Stimulant use and bone health in US children and adolescents: analysis of the NHANES data. Eur J Pediatr 181, 1633–1642 (2022). https://doi.org/10.1007/s00431-021-04356-w

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