# Pediatric Bone Health and Attention-Deficit/Hyperactivity Disorder (ADHD) Stimulants: Raising Awareness of Avascular Necrosis Risk

## TL;DR

This paper highlights the potential risk of avascular necrosis in children with ADHD who are on stimulant medications and have orthopedic injuries.

## Contribution

It raises awareness of a novel association between ADHD stimulants and avascular necrosis risk in pediatric patients.

## Key findings

- A case of avascular necrosis was observed in a child with ADHD following injury and stimulant use.
- Stimulant effects on bone metabolism and vascular tone may increase avascular necrosis risk.
- Non-weight-bearing adherence challenges in ADHD patients could worsen outcomes.

## Abstract

Avascular necrosis (AVN) is a rare but serious complication of pediatric musculoskeletal injury, traditionally associated with corticosteroid use, trauma, or systemic disease. However, stimulant medications used to treat attention-deficit/hyperactivity disorder (ADHD) may contribute to AVN risk through effects on bone metabolism and vascular tone, including reduced bone mineral density and increased sympathetic activity.

In clinical practice, we observed a case of AVN in a child with ADHD following lower-extremity injury and stimulant use, raising concern about the interplay between the physiological effects of medication and challenges in treatment adherence. Children with ADHD may struggle with non-weight-bearing protocols and follow-up care, which could further elevate the risk of complications.

This article aims to raise awareness of the potential intersection between ADHD stimulant therapy and AVN risk in pediatric patients with orthopedic injuries. We urge clinicians to maintain a high index of suspicion for AVN in this population, particularly when symptoms persist despite appropriate management. Multidisciplinary care and enhanced education for patients and caregivers are critical to ensuring adherence and preventing long-term joint damage.

Further research is warranted to explore the possible association between stimulant use and AVN and to guide best practices for prevention and management.