Naralan Yüksel Sümeyra, Demirel Esra
Department of Child and Adolescent Psychiatry, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkiye.
Department of Orthopaedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye.
Turk J Med Sci. 2025 Jul 3;55(4):940-948. doi: 10.55730/1300-0144.6047. eCollection 2025.
BACKGROUND/AIM: Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized not only for its behavioral and cognitive challenges but also for its potential implications in physical health, particularly injury risk. This study aimed to investigate the incidence of extremity fractures among children and adolescents diagnosed with ADHD, and to evaluate the influence of demographic, clinical, and pharmacological variables-including ADHD subtypes and medication types-on fracture risk.
This retrospective cross-sectional study included 754 children and adolescents aged 6-18 years old who were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5 criteria. Data were collected from electronic health records at a tertiary referral hospital. Variables analyzed included age, sex, ADHD subtype, intelligence quotient (IQ) level, pharmacological treatment status (methylphenidate or atomoxetine), comorbid psychiatric and medical conditions, and fracture history confirmed by clinical and radiological evidence. Binary logistic regression analysis was conducted to identify independent predictors of fracture risk.
The overall incidence of extremity fractures was 15%, with 69% occurring in the upper extremities. Children using ADHD medication had significantly lower fracture rates (9.7%) compared to untreated peers (32.6%, p < 0.001). Logistic regression showed that both methylphenidate (OR = 0.396) and atomoxetine (OR = 0.138) were associated with reduced fracture risk. The inattentive subtype also showed a protective effect. Other factors, such as age, sex, IQ, and comorbidities, were not significantly associated with fracture incidence.
This study highlights a notable reduction in extremity fracture risk among children with ADHD receiving pharmacological treatment, suggesting a possible protective role of stimulant and nonstimulant medications. Subtype-specific risk profiles further emphasize the importance of personalized approaches in ADHD management strategies.
背景/目的：注意力缺陷多动障碍（ADHD）不仅因其行为和认知方面的挑战而日益受到关注，还因其对身体健康的潜在影响，尤其是受伤风险。本研究旨在调查被诊断为ADHD的儿童和青少年四肢骨折的发生率，并评估人口统计学、临床和药理学变量（包括ADHD亚型和药物类型）对骨折风险的影响。
这项回顾性横断面研究纳入了754名6至18岁的儿童和青少年，他们根据《精神疾病诊断与统计手册》第5版标准被诊断为ADHD。数据从一家三级转诊医院的电子健康记录中收集。分析的变量包括年龄、性别、ADHD亚型、智商（IQ）水平、药物治疗状况（哌甲酯或托莫西汀）、共病的精神和身体疾病，以及经临床和放射学证据证实的骨折病史。进行二元逻辑回归分析以确定骨折风险的独立预测因素。
四肢骨折的总体发生率为15%，其中69%发生在上肢。与未接受治疗的同龄人（32.6%，p<0.001）相比，使用ADHD药物的儿童骨折率显著较低（9.7%）。逻辑回归显示，哌甲酯（OR=0.396）和托莫西汀（OR=0.138）均与骨折风险降低有关。注意力不集中型亚型也显示出保护作用。其他因素，如年龄、性别、智商和共病，与骨折发生率无显著关联。
本研究强调接受药物治疗的ADHD儿童四肢骨折风险显著降低，提示兴奋剂和非兴奋剂药物可能具有保护作用。特定亚型的风险特征进一步强调了在ADHD管理策略中采用个性化方法的重要性。
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