Chirokikh Alexander A, Uddin Sardar M Z, Areikat Nadine, Jones Rachel, Duque Edie, Connor Carly, Hadjiargyrou Michael, Thanos Panayotis K, Komatsu David E
University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America.
Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, United States of America.
Bone. 2023 Feb;167:116637. doi: 10.1016/j.bone.2022.116637. Epub 2022 Nov 30.
Methylphenidate (MP) is frequently prescribed to treat Attention-Deficit/Hyperactivity Disorder (ADHD); however, many patients with ADHD experience depression and anxiety. As such, concomitant administration of selective serotonin reuptake inhibitors such as fluoxetine (FLX) is common. Our laboratory and others have shown that MP impairs skeletal development in preclinical and clinical settings, and FLX has also been linked to skeletal deficits. Unfortunately, little is known about the effects of combined MP and FLX treatment on skeletal development. The objective of this study was to investigate the effects of MP and FLX on bone morphology and biomechanical properties in adolescent rats. Four-week-old male Sprague-Dawley rats were randomly divided into the following 4 groups: Water, MP, FLX, and MP + FLX. As body weights in the MP, FLX, and MP + FLX groups were all lower than Water, the data were compared directly and after adjusting to body weight via linear regression. The direct comparison revealed that MP + FLX rats had significantly shorter (12 %) and narrower femora and tibiae (10 %) compared to most other groups, along with shorter (26-35 %), disorganized tibial growth plates. MicroCT analyses of the trabecular compartment of the proximal tibia identified reductions of 47 % for TV, 86 % for BV, 74 % for BV/TV, 68 % for Tb.N, 25 % in Tb.Th, and 74 % in vBMD concomitant with increases of 44 % for Tb.Sp for MP + FLX compared to Water. Similar analyses of femoral midshaft cortical bone identified reductions of 29 % for Ct.V, 30 % for Ps.V, 30 % for Ec. V, and 51 % for pMOI, as well as increases of 17 % for Ct.Th and 2 % for TMD for MP + FLX compared to Water. Biomechanically, MP + FLX femora were weaker, as indicated by a reduction in ultimate force (14 %) in MP + FLX compared to Water. The microstructural and biomechanical effects of MP + FLX were eliminated after adjustment for body weight, though the detrimental effects on growth plate morphology remained. We conclude that while the adverse microstructural and biomechanical effects of MP + FLX seen via direct comparison are predominantly attributable to reductions in body weight rather than direct effects on bone, MP and FLX, particularly in combination show detrimental effects on growth plate structure and chondrocyte morphology. These findings warrant further research into the effect of these drugs on weight gain, skeletal development and growth plate morphology, as well as consideration by physicians treating children and adolescents with ADHD.
哌甲酯(MP)常用于治疗注意力缺陷多动障碍(ADHD);然而,许多ADHD患者会经历抑郁和焦虑。因此,同时服用选择性5-羟色胺再摄取抑制剂如氟西汀(FLX)很常见。我们实验室和其他研究表明,MP在临床前和临床环境中会损害骨骼发育,并且FLX也与骨骼缺陷有关。不幸的是,关于MP和FLX联合治疗对骨骼发育的影响知之甚少。本研究的目的是调查MP和FLX对青春期大鼠骨骼形态和生物力学特性的影响。四周龄雄性斯普拉格-道利大鼠被随机分为以下4组:水对照组、MP组、FLX组和MP + FLX组。由于MP组、FLX组和MP + FLX组的体重均低于水对照组,因此直接比较了数据,并通过线性回归将体重调整后进行比较。直接比较显示,与大多数其他组相比,MP + FLX组大鼠的股骨和胫骨明显更短(约12%)、更窄(约10%),胫骨生长板也更短(26 - 35%)且结构紊乱。对胫骨近端小梁骨区域的MicroCT分析表明,与水对照组相比,MP + FLX组的骨小梁体积(TV)减少了47%,骨小梁骨量(BV)减少了86%,骨小梁骨量与骨小梁体积之比(BV/TV)减少了74%,骨小梁数量(Tb.N)减少了68%,骨小梁厚度(Tb.Th)减少了25%,体积骨密度(vBMD)减少了74%,而骨小梁间距(Tb.Sp)增加了44%。对股骨干中段皮质骨的类似分析表明,与水对照组相比,MP + FLX组的皮质骨体积(Ct.V)减少了29%,骨膜周长(Ps.V)减少了30%,皮质骨面积(Ec.V)减少了30%,极惯性矩(pMOI)减少了51%,同时皮质骨厚度(Ct.Th)增加了17%,骨密度(TMD)增加了2%。生物力学方面,与水对照组相比,MP + FLX组的股骨更脆弱,表现为极限力降低(14%)。在调整体重后,MP + FLX的微观结构和生物力学效应消失了,尽管对生长板形态的有害影响仍然存在。我们得出结论,虽然通过直接比较观察到的MP + FLX的不良微观结构和生物力学效应主要归因于体重减轻而非对骨骼的直接影响,但MP和FLX,特别是联合使用时,对生长板结构和软骨细胞形态有有害影响。这些发现值得进一步研究这些药物对体重增加、骨骼发育和生长板形态的影响,也值得治疗儿童和青少年ADHD的医生考虑。