Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine , Providence, RI, USA.
Phys Sportsmed. 2020 Nov;48(4):412-416. doi: 10.1080/00913847.2020.1725400. Epub 2020 Feb 13.
: Current literature is divided on the effect of methylphenidate (MP) on stress fracture development and if this medication increases fracture, or is actually protective for it. This study further investigates this effect utilizing a large national database. We hypothesized that individuals on MP would have a reduced risk of SF compared against controls. : This study utilized the Humana insurance data set within the PearlDiver Patient Records Database (PearlDiver Inc, Fort Wayne, Indiana). All patients' ages 10-29 were included and patients were identified without ADHD, with ADHD not on MP, and with ADHD on MP. ADHD and stress fracture diagnoses were identified by codes. Bivariate analysis of stress fracture occurrence was conducted using chi-square analysis. Multivariate logistic regression was used to calculate odds ratios, controlling for age, sex, race, and Charlson Comorbidity Index (CCI). Statistical analysis was performed using the PearlDiver software, which runs R, Version 1.1.442. An α value of .05 was set as the level of significance. : The study included 29,590 patients on MP and 831,439 patients not on MP from ages 10-29. The highest proportions of patients who filled MP prescriptions were in the age range 10 to 14 years old (51.2%), followed by 15 to 19 (41.0%). Patients rarely continue MP from years 20 to 24 (16.5%) or 25 to 29 (9.6%). ADHD patients on MP had the lowest calculated risk of stress fractures (0.45%) compared to patients without ADHD (0.54%) and ADHD patients not on methylphenidate (0.58%). In all three patient groups, most stress fractures occurred in 15 to 19-year olds. Patients with ADHD on MP conferred lower odds of stress fracture than ADHD patients not on MP and patients without ADHD (aOR = 0.64, p = 0.0002). The older 20-24 and 25-29 involved less risk of stress fracture compared to the youngest age group 10-14 (p < 0.0001; p < 0.0001), as well as did male gender (p < 0.0001). : This study of the effect of MP on SF adds to the growing body of literature providing evidence that MP may offer protective benefit for stress fracture.
：目前的文献对于哌醋甲酯（MP）对应力性骨折发展的影响存在分歧，也不确定这种药物是否会增加骨折风险，或者实际上对其具有保护作用。本研究利用大型国家数据库进一步探讨了这种影响。我们假设，与对照组相比，服用 MP 的个体发生 SF 的风险降低。：本研究利用 Humana 保险数据集，数据集来源于 PearlDiver 患者记录数据库（PearlDiver Inc，印第安纳州韦恩堡）。纳入所有年龄在 10-29 岁的患者，根据是否患有 ADHD、是否服用 MP 以及是否患有 ADHD 且服用 MP 将患者分为四组。ADHD 和应力性骨折的诊断通过 ICD 编码确定。使用卡方分析对 SF 发生情况进行双变量分析。多变量逻辑回归用于计算比值比，同时控制年龄、性别、种族和 Charlson 合并症指数（CCI）。使用 PearlDiver 软件进行统计分析，该软件运行 R 版本 1.1.442。α 值设为 0.05，以表示显著性水平。：研究纳入了年龄在 10-29 岁之间的 29590 名服用 MP 的患者和 831439 名未服用 MP 的患者。服用 MP 处方的患者中，年龄在 10-14 岁的比例最高（51.2%），其次是 15-19 岁（41.0%）。20-24 岁和 25-29 岁的患者很少继续服用 MP（分别为 16.5%和 9.6%）。与无 ADHD 患者（0.54%）和未服用哌醋甲酯的 ADHD 患者（0.58%）相比，服用 MP 的 ADHD 患者发生应力性骨折的风险最低（0.45%）。在所有三组患者中，大多数应力性骨折发生在 15-19 岁。与未服用 MP 的 ADHD 患者和无 ADHD 患者相比，服用 MP 的 ADHD 患者发生应力性骨折的几率更低（aOR=0.64，p=0.0002）。与年龄最小的 10-14 岁组相比，年龄较大的 20-24 岁和 25-29 岁组发生应力性骨折的风险较低（p<0.0001；p<0.0001），男性也是如此（p<0.0001）。：本研究探讨了 MP 对 SF 的影响，这一研究增加了越来越多的文献证据，表明 MP 可能对应力性骨折具有保护作用。
