School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Meuhedet Health Services, Tel Aviv, Israel.
Eur J Pediatr. 2023 Jun;182(6):2705-2714. doi: 10.1007/s00431-023-04929-x. Epub 2023 Apr 1.
To analyse the risk of fractures among children with attention-deficit/hyperactivity disorder (ADHD) compared with matched children without ADHD; and to evaluate the impact of pharmacological treatment. This registry-based cohort study included 31,330 children diagnosed with ADHD and a comparison group of 62,660 children matched by age, sex, population sector and socioeconomic status. Demographic and clinical information was extracted from the electronic database of Meuhedet, a health maintenance organization. Fracture events between 2-18 years of age were identified by coded diagnoses. The overall fracture incidence rate was 334 per 10,000 patient-years (PY) in the ADHD group and 284 per 10,000 PY in the comparison group (p < 0.001). Among boys, the fracture incidence rates were 388 per 10,000 PY and 327 per 10,000 PY (p < 0.001), for the respective groups. Among girls, the rates were lower in both groups compared to boys, but higher in the ADHD compared to the matched group (246 vs 203 per 10,000 PY, p < 0.001). Among the children with ADHD, the hazard ratios (HR) to have a fracture were similar in boys (1.18, 95%CI 1.15-1.22, p < 0.001) and girls (1.22, 95%CI 1.16-1.28, p < 0.001). Children with ADHD were also at increased risk for two and three fractures; the hazard ratios (HRs) were 1.32 (95%CI 1.26-1.38, p < 0.001) and 1.35 (95%CI 1.24-1.46, p < 0.001), respectively. In a multivariable model of the children with ADHD, pharmacological treatment was associated with reduced fracture risk (HR 0.90, 95%CI 0.82-0.98, p < 0.001) after adjustment for sex, resident socioeconomic status and population sector. Conclusion: Children with ADHD had greater fracture risk than a matched group without ADHD. Pharmacological treatment for ADHD may decrease this risk. What is Known: • Children with attention-deficit/hyperactivity disorder (ADHD) may be more prone to injuries and fractures than children without ADHD. What is New: • Children with ADHD were 1.2 times more likely to have a fracture than children with similar characteristics, without ADHD. The increased risk for fractures was even greater for two and three fractures (hazard ratios 1.32 and 1.35, respectively). • Our study suggests a positive effect of pharmacological treatment for ADHD in reducing fracture risk.
分析患有注意缺陷多动障碍 (ADHD) 的儿童与无 ADHD 的匹配儿童相比骨折的风险；并评估药物治疗的影响。这项基于登记的队列研究纳入了 31330 名被诊断为 ADHD 的儿童和 62660 名年龄、性别、人口部门和社会经济地位相匹配的对照组儿童。从 Meuhedet 的电子数据库中提取人口统计学和临床信息，这是一家健康维护组织。通过编码诊断确定 2-18 岁之间的骨折事件。ADHD 组的总体骨折发生率为每 10000 患者年 334 例（PY），对照组为每 10000 PY 284 例（p<0.001）。在男孩中，ADHD 组和对照组的骨折发生率分别为每 10000 PY 388 例和 327 例（p<0.001）。在女孩中，两组的发病率均低于男孩，但 ADHD 组高于对照组（每 10000 PY 246 例比 203 例，p<0.001）。在 ADHD 儿童中，男孩（1.18，95%CI 1.15-1.22，p<0.001）和女孩（1.22，95%CI 1.16-1.28，p<0.001）的骨折风险比（HR）相似。ADHD 儿童也有更高的两到三处骨折风险；风险比（HRs）分别为 1.32（95%CI 1.26-1.38，p<0.001）和 1.35（95%CI 1.24-1.46，p<0.001）。在 ADHD 儿童的多变量模型中，在调整性别、居住社会经济地位和人口部门后，药物治疗与降低骨折风险相关（HR 0.90，95%CI 0.82-0.98，p<0.001）。结论：患有 ADHD 的儿童比没有 ADHD 的匹配组有更高的骨折风险。ADHD 的药物治疗可能会降低这种风险。已知：•患有注意缺陷多动障碍 (ADHD) 的儿童可能比没有 ADHD 的儿童更容易受伤和骨折。新发现：•与具有相似特征且没有 ADHD 的儿童相比，患有 ADHD 的儿童骨折的可能性高 1.2 倍。两到三处骨折的风险更高（风险比分别为 1.32 和 1.35）。•我们的研究表明，ADHD 的药物治疗对降低骨折风险有积极影响。
