[Note to reader: This Quick Read adaptation simplifies the original, more detailed article by using less technical language. For the full article, please click here.]

Having clear skin could be a great boost to your confidence, but is it worth sacrificing potential height for? The evidence for Accutane’s effects on the musculoskeletal system is extensive. In fact, as many half the patients treated with Accutane report experiencing back pain. [1] Whilst prescribers might be inclined to dismiss skeletal pain as just another pesky side effect, it’s happening for very real reasons. Studies have found that retinoic acid (the primary metabolite of Accutane) causes an increase the cells that break down bone tissue called Osteoclasts. [2] This perhaps why Accutane can cause a significant increase in the risk of bone fracturing and even osteoporosis. [3]

Why does Accutane do this? Well, it’s partially to do with a troublesome amino acid called homocysteine. You definitely don’t want too much homocysteine in your blood, as elevated homocysteine puts you at greater risk of heart disease, stroke and even depression. Typically, homocysteine is broken down by B-vitamins such as B12. Unfortunately Accutane disrupts this process, and the elevated homocysteine is allowed to wreak havoc throughout the body, including your bones! When homocysteine accumulates in the bones it boosts the effect of those “bone-eating” cells called Osteoclasts but suppresses the bone forming cells called Osteoblasts. [3] Thankfully, this excess homocysteine can be broken down by supplementing with B12 and folate. Supplementing in this way is so effective at breaking down homocysteine, it can even resolve skeletal pain caused by the acne medication. [4]

The damaging effects of Accutane aren’t just limited to the bone however, but also to the cartilage within joints. Like the effect of its effect on bones, Accutane shifts the body’s homeostasis in the direction of breaking down cartilage structures. [5] This could be a particular point of concern for anyone who was treated with the retinoid during that key period of growth during teenagerhood, as cartilage is crucial for the healthy development of bones. The process of skeletal development, called Endochondral ossification, relies on cartilage as a template for new bone growth. Accutane can kill the cells that grow new cartilage needed for bone development. [6] It’s therefore no surprise that there’s a growing body of evidence that prematurely close growth plates, preventing teenagers treated with the drug from reaching their full potential height. [7] It’s hard to say exactly how significant this effect is, as it’ll depend on individual factors, but there’s one case study suggesting a possible loss of up to 5cm of height! [8]

Fascinatingly, a lesser-known trace metal in food, Lithium, exhibits effects contrary to those of Accutane on bones and joints. The effect of Lithium on cartilage mirrors that of Accutane because it has the opposite effect on a growth protein called beta-catenin. [9][10] Whilst Accutane breaks down cartilage and bone, Lithium grows them. Incredibly this effect is so profound that it can even boost height development in animal studies. [11] Whilst Lithium is more commonly known as a mood stabiliser, it does exist in very low levels some foods and even tap water. Lithium is available in low dose supplemental formulations and might yet prove to be effective in mitigating the nasty side effects of Accutane treatment.

Related Articles

Why Accutane Can Cause Joint Pain and Stunted Growth

References