Schermann Haggai, Gurel Ron, Ankory Ran, Kadar Assaf, Yoffe Victoria, Snir Nimrod, Sternheim Amir, Karakis Isabella
Divison of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Weizmann 6, Tel Aviv, Israel.
National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
J Orthop Res. 2018 Dec;36(12):3328-3333. doi: 10.1002/jor.24129. Epub 2018 Sep 7.
Methylphenidate (MP), a widely used and abused stimulant medication for ADHD, negatively affects bone mass. However, previous epidemiological studies demonstrated that MP is not associated with increased incidence of fractures in children, and may even have a protective effect due to behavior modification. This study aimed to investigate the association between MP and fracture risk in a retrospective cohort of healthy military recruits, aged 18-25, with at least 1 year of service between 2008 and 2017. Subjects were divided into five groups: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1-90, 91-180, or 181+ tablets during the study period. The primary outcome was at least one fracture diagnosis during the study. Among 682,110 subjects (409,175 men [60%]), 50,999 (7.5%) had fractures. MP was used by 1,681 (0.4%) men and 2.828 (1%) women. The fracture rates in the no ADHD, untreated ADHD, ADHD 0-90, ADHD 91-180, and ADHD 181+ groups were 10.4%, 16.4%, 8.7%, 4.8% and 5.8% in men, and 3.6%, 7.1%, 4.6%, 4.4% and 3% in women, respectively. Multivariate regression analysis confirmed an inverse dose-response association between MP and fractures in men (p < 0.001). In women, untreated ADHD was associated with a significantly higher fracture risk, compared to healthy controls (OR = 1.82, p < 0.001). The study confirms previous literature and demonstrates an inverse dose-response association between MP and fracture risk in men. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3328-3333, 2018.
哌甲酯（MP）是一种广泛用于治疗注意力缺陷多动障碍（ADHD）但也存在滥用情况的兴奋剂药物，它会对骨量产生负面影响。然而，先前的流行病学研究表明，MP与儿童骨折发生率增加并无关联，甚至可能由于行为改变而具有保护作用。本研究旨在调查在2008年至2017年期间服役至少1年、年龄在18至25岁的健康新兵回顾性队列中，MP与骨折风险之间的关联。研究对象被分为五组：无ADHD的受试者；未接受治疗的ADHD受试者；以及在研究期间有ADHD且分别开具1至90片、91至180片或181片以上处方的受试者。主要结局是在研究期间至少有一次骨折诊断。在682,110名受试者（409,175名男性[60%]）中，50,999人（7.5%）发生了骨折。1,681名（0.4%）男性和2,828名（1%）女性使用了MP。在男性中，无ADHD组、未治疗ADHD组、ADHD 0至90片组、ADHD 91至180片组和ADHD 181片以上组的骨折率分别为10.4%、16.4%、8.7%、4.8%和5.8%；在女性中，相应骨折率分别为3.6%、7.1%、4.6%、4.4%和3%。多因素回归分析证实，男性中MP与骨折之间存在剂量反应负相关（p < 0.001）。在女性中，与健康对照组相比，未治疗的ADHD与骨折风险显著升高相关（OR = 1.82，p < 0.001）。该研究证实了先前的文献，并表明男性中MP与骨折风险之间存在剂量反应负相关。© 2018年骨科学研究协会。由威利期刊公司出版。《矫形外科学研究杂志》36:3328 - 3333，2018年。
