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).
Poulton A, Lee KNW. Stimulant Use and Bone Mineral Density. JAMA Pediatr. 2017;171(5):494–495. doi:10.1001/jamapediatrics.2017.0180
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