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Archives of Osteoporosis

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01-12-2021 | Review Article

ADHD, stimulant medication use, and the risk of fracture: a systematic review and meta-analysis

Authors: Shao-Wen Zhang, Dan Shen, Yue-tai Yan

Published in: Archives of Osteoporosis | Issue 1/2021

Abstract

Summary

We performed a meta-analysis to quantify the relationships among a diagnosis of attention-deficit/hyperactivity disorder (ADHD), the use of stimulant medication, and the risk of fracture. There was a significant positive association between ADHD and the risk of fracture. However, stimulant ADHD medication therapy appears to be associated with a reduced risk of fracture in patients with ADHD.

Introduction

ADHD is associated with an increased fracture risk due to a lack of impulse control. ADHD medication may have a protective effect via behavior modification. However, previous research found an adverse effect of stimulant use on bone mass. Therefore, this meta-analysis study assessed the relationships among ADHD, the use of stimulant medication, and fracture risk.

Methods

A literature search was conducted using PubMed and EMBASE from inception through December 2020. Random-effects models were used to determine overall pooled estimates and 95% confidence intervals (CIs).

Results

The meta-analysis included 10 observational studies. Our results showed that ADHD diagnosis is associated with an increased risk of fracture (OR = 1.17; 1.01–1.35, p = 0.035). Notably, a higher risk of fracture (OR = 1.37, 95% CI 1.2–1.58, p < 0.001) was observed in non-stimulant-treated ADHD. However, no significant association, but a trend toward a lower risk, was observed for stimulant-treated ADHD patients compared with non-stimulant-treated ADHD patients (OR = 0.7, 95% CI 0.47–1.03, p = 0.073). In terms of fracture type, non-stimulant-treated ADHD was associated with traumatic fracture (OR = 1.79, 95% CI 1.54–2.08, p < 0.001) or stress fracture (OR = 1.12, 95% CI 1.04–1.2, p = 0.004) compared to healthy control (HC). In addition, further findings from our systematic review showed that the risk of traumatic (OR = 1, 95% CI 0.88–1.13, p = 0.954) or stress (OR = 0.84, 95% CI 0.62–1.14, p = 0.256) fracture was comparable between treated stimulant-ADHD patients and HC.

Conclusions

Individuals with ADHD are at higher risk of fracture than the general population. Stimulant ADHD medication appears to be associated with a lower risk of traumatic fracture but not with a higher risk of stress fracture.

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Title: ADHD, stimulant medication use, and the risk of fracture: a systematic review and meta-analysis
Authors: Shao-Wen Zhang
Dan Shen
Yue-tai Yan
Publication date: 01-12-2021
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-021-00960-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

ADHD, stimulant medication use, and the risk of fracture: a systematic review and meta-analysis

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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