Skip to main content
Top
Published in: Osteoporosis International 4/2017

01-04-2017 | Original Article

Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices

Authors: L. Jacob, K. Kostev

Published in: Osteoporosis International | Issue 4/2017

Login to get access

Abstract

Summary

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.

Introduction

The aim of this study was to analyze the impact of ADHD therapy on fracture risk in children treated by German pediatricians.

Methods

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.

Results

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).

Conclusion

ADHD therapy was associated with a decrease in the risk of fracture in children and adolescents treated by German pediatricians.
Literature
1.
go back to reference Tseng MH, Henderson A, Chow SMK, Yao G (2004) Relationship between motor proficiency, attention, impulse, and activity in children with ADHD. Dev Med Child Neurol 46(6):381–8CrossRefPubMed Tseng MH, Henderson A, Chow SMK, Yao G (2004) Relationship between motor proficiency, attention, impulse, and activity in children with ADHD. Dev Med Child Neurol 46(6):381–8CrossRefPubMed
2.
go back to reference Blank R, Smits-Engelsman B, Polatajko H, Wilson P (2012) European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version)*. Dev Med Child Neurol 54(1):54–93CrossRefPubMed Blank R, Smits-Engelsman B, Polatajko H, Wilson P (2012) European Academy for Childhood Disability (EACD): recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version)*. Dev Med Child Neurol 54(1):54–93CrossRefPubMed
3.
go back to reference Sharma A, Couture J (2014) A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother 48(2):209–25CrossRefPubMed Sharma A, Couture J (2014) A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD). Ann Pharmacother 48(2):209–25CrossRefPubMed
4.
go back to reference Erskine HE, Ferrari AJ, Polanczyk GV, Moffitt TE, Murray CJL, Vos T et al (2014) The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J Child Psychol Psychiatry 55(4):328–36CrossRefPubMed Erskine HE, Ferrari AJ, Polanczyk GV, Moffitt TE, Murray CJL, Vos T et al (2014) The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J Child Psychol Psychiatry 55(4):328–36CrossRefPubMed
5.
go back to reference Thomas R, Sanders S, Doust J, Beller E, Glasziou P (2015) Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics: 2014–3482 Thomas R, Sanders S, Doust J, Beller E, Glasziou P (2015) Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics: 2014–3482
6.
go back to reference Huss M, Hölling H, Kurth B-M, Schlack R (2008) How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgment of health care professionals: results of the German health and examination survey (KiGGS). Eur Child Adolesc Psychiatry 17(Suppl 1):52–8CrossRefPubMed Huss M, Hölling H, Kurth B-M, Schlack R (2008) How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgment of health care professionals: results of the German health and examination survey (KiGGS). Eur Child Adolesc Psychiatry 17(Suppl 1):52–8CrossRefPubMed
7.
go back to reference Chou I-C, Lin C-C, Sung F-C, Kao C-H (2014) Attention-deficit-hyperactivity disorder increases risk of bone fracture: a population-based cohort study. Dev Med Child Neurol 56(11):1111–6CrossRefPubMed Chou I-C, Lin C-C, Sung F-C, Kao C-H (2014) Attention-deficit-hyperactivity disorder increases risk of bone fracture: a population-based cohort study. Dev Med Child Neurol 56(11):1111–6CrossRefPubMed
8.
go back to reference Guo N-W, Lin C-L, Lin C-W, Huang M-T, Chang W-L, Lu T-H et al (2016) Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: a nationwide matched study. J Pediatr Orthop Part B 25(4):369–74CrossRef Guo N-W, Lin C-L, Lin C-W, Huang M-T, Chang W-L, Lu T-H et al (2016) Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: a nationwide matched study. J Pediatr Orthop Part B 25(4):369–74CrossRef
9.
go back to reference Dalsgaard S, Leckman JF, Mortensen PB, Nielsen HS, Simonsen M (2015) Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study. Lancet Psychiatry 2(8):702–9CrossRefPubMed Dalsgaard S, Leckman JF, Mortensen PB, Nielsen HS, Simonsen M (2015) Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study. Lancet Psychiatry 2(8):702–9CrossRefPubMed
10.
go back to reference Perry BA, Archer KR, Song Y, Ma Y, Green JK, Elefteriou F et al (2016) Medication therapy for attention deficit/hyperactivity disorder is associated with lower risk of fracture: a retrospective cohort study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 27(7):2223–7 Perry BA, Archer KR, Song Y, Ma Y, Green JK, Elefteriou F et al (2016) Medication therapy for attention deficit/hyperactivity disorder is associated with lower risk of fracture: a retrospective cohort study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 27(7):2223–7
11.
go back to reference Vestergaard P, Rejnmark L, Mosekilde L (2008) Selective serotonin reuptake inhibitors and other antidepressants and risk of fracture. Calcif Tissue Int 82(2):92–101CrossRefPubMed Vestergaard P, Rejnmark L, Mosekilde L (2008) Selective serotonin reuptake inhibitors and other antidepressants and risk of fracture. Calcif Tissue Int 82(2):92–101CrossRefPubMed
12.
go back to reference Coupland C, Dhiman P, Morriss R, Arthur A, Barton G, Hippisley-Cox J (2011) Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 343:d4551CrossRefPubMedPubMedCentral Coupland C, Dhiman P, Morriss R, Arthur A, Barton G, Hippisley-Cox J (2011) Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 343:d4551CrossRefPubMedPubMedCentral
13.
go back to reference Coupland CC, Dhiman P, Barton G, Morriss R, Arthur A, Sach T et al (2011) A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. Health Technol Assess Winch Eng 15(28):1–202, iii–iv Coupland CC, Dhiman P, Barton G, Morriss R, Arthur A, Sach T et al (2011) A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. Health Technol Assess Winch Eng 15(28):1–202, iii–iv
14.
go back to reference Becher H, Kostev K, Schröder-Bernhardi D (2009) Validity and representativeness of the “Disease Analyzer” patient database for use in pharmacoepidemiological and pharmacoeconomic studies. Int J Clin Pharmacol Ther 47(10):617–26CrossRefPubMed Becher H, Kostev K, Schröder-Bernhardi D (2009) Validity and representativeness of the “Disease Analyzer” patient database for use in pharmacoepidemiological and pharmacoeconomic studies. Int J Clin Pharmacol Ther 47(10):617–26CrossRefPubMed
15.
go back to reference Hood J, Baird G, Rankin PM, Isaacs E (2005) Immediate effects of methylphenidate on cognitive attention skills of children with attention-deficit-hyperactivity disorder. Dev Med Child Neurol 47(6):408–13CrossRefPubMed Hood J, Baird G, Rankin PM, Isaacs E (2005) Immediate effects of methylphenidate on cognitive attention skills of children with attention-deficit-hyperactivity disorder. Dev Med Child Neurol 47(6):408–13CrossRefPubMed
16.
go back to reference Wernicke JF, Holdridge KC, Jin L, Edison T, Zhang S, Bangs ME et al (2007) Seizure risk in patients with attention-deficit-hyperactivity disorder treated with atomoxetine. Dev Med Child Neurol 49(7):498–502CrossRefPubMed Wernicke JF, Holdridge KC, Jin L, Edison T, Zhang S, Bangs ME et al (2007) Seizure risk in patients with attention-deficit-hyperactivity disorder treated with atomoxetine. Dev Med Child Neurol 49(7):498–502CrossRefPubMed
17.
go back to reference Lahat E, Weiss M, Ben-Shlomo A, Evans S, Bistritzer T (2000) Bone mineral density and turnover in children with attention-deficit hyperactivity disorder receiving methylphenidate. J Child Neurol 15(7):436–9CrossRefPubMed Lahat E, Weiss M, Ben-Shlomo A, Evans S, Bistritzer T (2000) Bone mineral density and turnover in children with attention-deficit hyperactivity disorder receiving methylphenidate. J Child Neurol 15(7):436–9CrossRefPubMed
18.
go back to reference Ma Y, Krueger JJ, Redmon SN, Uppuganti S, Nyman JS, Hahn MK et al (2013) Extracellular norepinephrine clearance by the norepinephrine transporter is required for skeletal homeostasis. J Biol Chem 288(42):30105–13CrossRefPubMedPubMedCentral Ma Y, Krueger JJ, Redmon SN, Uppuganti S, Nyman JS, Hahn MK et al (2013) Extracellular norepinephrine clearance by the norepinephrine transporter is required for skeletal homeostasis. J Biol Chem 288(42):30105–13CrossRefPubMedPubMedCentral
19.
go back to reference Mannuzza S, Klein RG, Truong NL, Moulton JL, Roizen ER, Howell KH et al (2008) Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. Am J Psychiatry 165(5):604–9CrossRefPubMedPubMedCentral Mannuzza S, Klein RG, Truong NL, Moulton JL, Roizen ER, Howell KH et al (2008) Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. Am J Psychiatry 165(5):604–9CrossRefPubMedPubMedCentral
20.
go back to reference Sabhaney V, Boutis K, Yang G, Barra L, Tripathi R, Tran TT et al (2014) Bone fractures in children: is there an association with obesity? J Pediatr 165(2):313–318CrossRefPubMed Sabhaney V, Boutis K, Yang G, Barra L, Tripathi R, Tran TT et al (2014) Bone fractures in children: is there an association with obesity? J Pediatr 165(2):313–318CrossRefPubMed
21.
go back to reference Dalsgaard S, Østergaard SD, Leckman JF, Mortensen PB, Pedersen MG (2015) Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet 385(9983):2190–6CrossRefPubMed Dalsgaard S, Østergaard SD, Leckman JF, Mortensen PB, Pedersen MG (2015) Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet 385(9983):2190–6CrossRefPubMed
Metadata
Title
Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices
Authors
L. Jacob
K. Kostev
Publication date
01-04-2017
Publisher
Springer London
Published in
Osteoporosis International / Issue 4/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-016-3842-x

Other articles of this Issue 4/2017

Osteoporosis International 4/2017 Go to the issue