The association between methylphenidate treatment and the risk for fracture among young ADHD patients: A nationwide population-based study in Taiwan

Abstract

Attention-deficit hyperactivity disorder (ADHD) is associated with higher risk for fracture. Whether the medical treatment for ADHD would mitigate the risk remains unclear. In this study, we sought to investigate the effect of methylphenidate treatment on risk for fracture, as well the moderational role of treatment duration on the risk of fracture, in a large national sample. Cases less than 18 years old were identified from Taiwan’s National Health Insurance Research Database with a new primary diagnosis of ADHD (ICD-9:314) between 1996 and 2013. A total of 6201 cases with ADHD were included as the study cohort. The cases were divided into 3 groups according to the duration of methylphenidate treatment (0, 1–180, and more than 180 days). All groups were followed until the end of 2013 for first diagnoses of fracture (ICD-9 codes 800 to 829). Cox proportional hazards models were applied. Compared to the group without methylphenidate treatment, the risk for fracture was lower among the group treated for more than 180 days. The adjusted hazard ratio was 0.77 (95% Confidence interval: 0.63–0.94). The groups treated for 180 days or fewer had no significant difference in the risk for fracture. In conclusion, methylphenidate treatment was associated with lower risk for fracture among ADHD patients. The association was evident only in the cohort treated for more than 180 days.

Effectiveness of Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder on Physical Injuries: A Systematic Review and Meta-Analysis of Observational Studies

“…Titles and abstracts were screened and full texts were retrieved for further assessment of 26 relevant records, of which 10 studies were found to be relevant. Six of the studies [6,[13][14][15][16][17] were conducted using nationwide databases, with two [15,16] from the same nationwide claim database in Taiwan, three others [4,18,19] from insurance claim databases and one [5] from GP database, all with substantial numbers of patients. All studies evaluated physical injuries as the outcome, which was defined as medically attended injuries at any point of care, identified diagnoses for injury on database records, or through entries for trauma or transport-related injuries on medical records.…”

Lower risk of fractures under methylphenidate treatment for ADHD: A dose–response effect

“…7 Another retrospective cohort study of more than 6,000 cases from Taiwan, reported an adjusted hazard ratio of 0.77 (95%CI, 0.63-0.94) among cases with ADHD treated with MP, compared to cases with ADHD who were not treated with MP. 6 The main important finding of this study is the establishment of a dose-response relationship between MP use and fracture incidence, which is one of the basic criteria for determining causation. 23 In addition, the present study shows that treatment of ADHD reduces the odds for fractures, despite its reportedly adverse effects on bone mineral density.…”

“…This stratification was based on the study by Chen et al, who found lower fracture incidence among subjects who used MP for more than 180 days, compared to subjects with ADHD who did not use it at all. 6 Fracture incidence in these five groups was presented as the percentage of subjects with fractures within each group. In addition, the unadjusted odds ratio (OR) of fractures was calculated for each group using logistic regression.…”

“…The prevalence of MP use is even higher. 1 Recent studies have shown the prevalence of MP prescriptions to be 7.5% in children aged [6][7][8][9][10][11][12][13][14][15][16][17][18] in Israel, 2 5% in children of the same age group in the United States, and 2.5-4.0% in adults in the United States. 3 Stimulants like MP have been estimated to be abused (used without prescription) in 5-10% of high school students and 5-35% of college students in the United States.…”

“…In fact, several studies have demonstrated the opposite: Treatment of ADHD with MP and other stimulants has been shown to reduce the risk of traumatic fractures. [6][7][8] Studies on military recruits have shown that a history of MP use during adolescence is associated with a higher risk of stress fractures during military service. 9,10 However, MP use by subjects with ADHD was reportedly not associated with an increased risk of traumatic fractures, when compared to subjects with untreated ADHD.…”