The Effect of Previous Methylphenidate Use on Incidence of Stress Fractures in Military Recruits

Abstract

Background: Previous research has detected an increased risk of stress fractures among subjects who reported previous use of methylphenidate. Conversely, stimulant medication use has been associated with traumatic fracture risk reduction, possibly because of the improved control of the underlying symptoms of attention deficit hyperactivity disorder (ADHD). The goal of this study was to investigate the effect of previous methylphenidate use on the incidence of traumatic and stress fractures among combat soldiers with previously treated and untreated ADHD. Methods: The retrospective cohort included 100,000 combat soldiers recruited to the Israeli Defense Forces from 2005 through 2015. Diagnosis of ADHD and previous exposure to methylphenidate were determined on the basis of self-reported recruitment questionnaires and medical records. Accordingly, the cohort was divided into 3 groups: subjects with ADHD who were previously treated with methylphenidate (n = 689), untreated subjects with ADHD reporting no medication use (n = 762), and controls having no ADHD diagnosis (n = 98,549). Logistic regressions were fitted to determine the odds ratios (ORs) of study subjects for stress and non-stress (traumatic) fractures. Multivariate analysis incorporated baseline characteristics, including age, sex, weight, duration of service, and diagnosis of anemia, at some point during the service. Results: After adjustment for sex, anemia, weight, age, and duration of service, the risk of traumatic fractures was increased in both subjects with treated ADHD (OR, 1.03 [95% confidence interval (CI), 1.00 to 1.05]) and subjects with untreated ADHD (OR, 1.04 [95% CI, 1.02 to 1.07]) compared with controls. Subjects in the treated ADHD group were at a higher risk of stress fractures (OR, 1.04 [95% CI, 1.02 to 1.07]). Interestingly, a diagnosis of anemia was an independent predictor of stress fractures (OR, 1.05 [95% CI, 1.04 to 1.06]). Conclusions: Methylphenidate use is associated with an increased risk of stress fractures but a decreased risk of traumatic fractures in individuals diagnosed with ADHD. These and previous findings may serve as sufficient basis for screening for other risk factors and perhaps taking prevention measures in all those using stimulant medications, especially those planning to engage in strenuous physical activity. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Methylphenidate use and restorative treatment in 13,000 young adults with ADHD

“…Methylphenidate (MP) is an effective stimulant medication for treatment of Attention Deficit and Hyperactivity Disorder (ADHD). Its use is prevalent in up to 7.5% of children of ages 6 to 18 and in up to 35% of college students (Ben-Ami et al, 2018). The research of the adverse effects of MP on patient health reported osteopenia (Feuer, Thai, Demmer, & Vogiatzi, 2016) and slower growth in children (Poulton et al, 2012), and an increased incidence of stress fractures in combat military recruits (Schermann et al, 2018).…”

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

“…[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. 10 The goal of this study was to investigate the association between treated and untreated ADHD and the risk of fracture, and to evaluate the dose-response relationship.…”

“…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. 10 The goal of this study was to investigate the association between treated and untreated ADHD and the risk of fracture, and to evaluate the dose-response relationship. A relatively large cohort of military recruits, representative of general population, and precise prescription data were used to achieve this goal.…”

“…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.…”

Stimulanzien in der Therapie einer ADHS sind schädlich für Wachstum und Knochendichte – Pro

“…Über eine Osteoporoseprävention bei mit Stimulanzien behandelten Kindern, Jugendlichen und Erwachsenen sollte nachgedacht werden, denn die Auswirkungen machen sich nicht erst im Alter bemerkbar, wie eine aktuelle israelische Untersuchung an Rekruten zeigt. Die Einnahme von Methylphenidat ist signifikant mit einer höheren Rate an Stressfrakturen assoziiert [9]. Da Stimulanzien zum Goldstandard in der Behandlung einer ADHS gehören, sollte neben einer profunden Aufklärung über individuelle Nebenwirkungen und einer im Verlauf immer wieder einzuschätzenden Nutzen-Risiko-Relation auch über Medikamentenpausen und deren Benefit für das Wachstum und die Knochenstruktur nachgedacht werden.…”