The association between methylphenidate treatment and the risk for fracture among young ADHD patients: A nationwide population-based study in Taiwan

PLoS One. 2017 Mar 15;12(3):e0173762. doi: 10.1371/journal.pone.0173762. eCollection 2017.

Abstract

Attention-deficit hyperactivity disorder (ADHD) is associated with higher risk for fracture. Whether the medical treatment for ADHD would mitigate the risk remains unclear. In this study, we sought to investigate the effect of methylphenidate treatment on risk for fracture, as well the moderational role of treatment duration on the risk of fracture, in a large national sample. Cases less than 18 years old were identified from Taiwan's National Health Insurance Research Database with a new primary diagnosis of ADHD (ICD-9:314) between 1996 and 2013. A total of 6201 cases with ADHD were included as the study cohort. The cases were divided into 3 groups according to the duration of methylphenidate treatment (0, 1-180, and more than 180 days). All groups were followed until the end of 2013 for first diagnoses of fracture (ICD-9 codes 800 to 829). Cox proportional hazards models were applied. Compared to the group without methylphenidate treatment, the risk for fracture was lower among the group treated for more than 180 days. The adjusted hazard ratio was 0.77 (95% Confidence interval: 0.63-0.94). The groups treated for 180 days or fewer had no significant difference in the risk for fracture. In conclusion, methylphenidate treatment was associated with lower risk for fracture among ADHD patients. The association was evident only in the cohort treated for more than 180 days.

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Child
  • Child, Preschool
  • Female
  • Fractures, Bone / chemically induced
  • Fractures, Bone / epidemiology*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Methylphenidate / adverse effects
  • Methylphenidate / therapeutic use*
  • Population Surveillance
  • Retrospective Studies
  • Taiwan / epidemiology

Substances

  • Methylphenidate

Grants and funding

The present study is supported in part by the Ministry of Science and Technology, R.O.C.(MOST 102-2314-B-040-004-MY3) and Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital (CMRPG6E0261,CORPG6D0162). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The study is based on the National Health Insurance Research Database provided by the Central Bureau of National Health Insurance, the Department of Health, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.