title: Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices.
abstract: Two thousand eight hundred ninety-four children and adolescents treated by 243 pediatricians were analyzed. Patients receiving attention deficit hyperactivity disorder (ADHD) medications were at a lower risk of fractures than patients without ADHD medications. The strongest impact was in the age group of 6-9 years. Finally, there was a significant association between therapy duration and fracture risk.
  
  
  
  The aim of this study was to analyze the impact of ADHD therapy on fracture risk in children treated by German pediatricians.
  
  
  
  Children and adolescents initially diagnosed with ADHD and fractures between 2010 and 2015 were identified by 243 pediatricians. In this nested case-control study, each ADHD case with a fracture was matched (1:1) to an ADHD control without a fracture for age, gender, index year, and physician. In total, 2894 individuals were available for analysis. The main outcome of the study was the risk of fracture as a function of ADHD therapy. Multivariate logistic regression models were created to determine the effect of ADHD therapy on the risk of fracture in the entire population and in three age-specific subgroups.
  
  
  
  Patients receiving ADHD medications were at a lower risk of fracture than patients without ADHD medications (OR = 0.61). The impact of ADHD therapy on the risk of fracture was stronger in the age group of 6-9 years (OR = 0.41) than in the age groups of 10-13 years (OR = 0.68) and 14-17 years (OR = 0.74). Finally, a significant correlation was found between therapy duration and fracture risk (OR = 0.71 per month).
  
  
  
  ADHD therapy was associated with a decrease in the risk of fracture in children and adolescents treated by German pediatricians.
authors.affiliation: Faculty of Medicine, University of Paris 5, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Jacob
authors.affiliation: Department of Epidemiology, IMS Health, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany. kkostev@de.imshealth.com.
authors.forename: K
authors.initials: K
authors.lastname: Kostev
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D016208:Databases, Factual; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D018570:Risk Assessment / Q000379:methods
chemical_list: D018759:Adrenergic Uptake Inhibitors
keywords: Attention deficit hyperactivity disorder; Children and adolescents; Fracture risk; Germany