Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices

Osteoporos Int. 2017 Apr;28(4):1265-1269. doi: 10.1007/s00198-016-3842-x. Epub 2016 Nov 24.

Abstract

Two thousand eight hundred ninety-four children and adolescents treated by 243 pediatricians were analyzed. Patients receiving attention deficit hyperactivity disorder (ADHD) medications were at a lower risk of fractures than patients without ADHD medications. The strongest impact was in the age group of 6-9 years. Finally, there was a significant association between therapy duration and fracture risk.

Introduction: The aim of this study was to analyze the impact of ADHD therapy on fracture risk in children treated by German pediatricians.

Methods: Children and adolescents initially diagnosed with ADHD and fractures between 2010 and 2015 were identified by 243 pediatricians. In this nested case-control study, each ADHD case with a fracture was matched (1:1) to an ADHD control without a fracture for age, gender, index year, and physician. In total, 2894 individuals were available for analysis. The main outcome of the study was the risk of fracture as a function of ADHD therapy. Multivariate logistic regression models were created to determine the effect of ADHD therapy on the risk of fracture in the entire population and in three age-specific subgroups.

Results: Patients receiving ADHD medications were at a lower risk of fracture than patients without ADHD medications (OR = 0.61). The impact of ADHD therapy on the risk of fracture was stronger in the age group of 6-9 years (OR = 0.41) than in the age groups of 10-13 years (OR = 0.68) and 14-17 years (OR = 0.74). Finally, a significant correlation was found between therapy duration and fracture risk (OR = 0.71 per month).

Conclusion: ADHD therapy was associated with a decrease in the risk of fracture in children and adolescents treated by German pediatricians.

Keywords: Attention deficit hyperactivity disorder; Children and adolescents; Fracture risk; Germany.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenergic Uptake Inhibitors / administration & dosage
  • Adrenergic Uptake Inhibitors / therapeutic use
  • Age Factors
  • Attention Deficit Disorder with Hyperactivity / complications*
  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Case-Control Studies
  • Child
  • Databases, Factual
  • Drug Administration Schedule
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Fractures, Bone / epidemiology
  • Fractures, Bone / etiology*
  • Fractures, Bone / prevention & control
  • Germany / epidemiology
  • Humans
  • Male
  • Risk Assessment / methods

Substances

  • Adrenergic Uptake Inhibitors