Publication:

Long-term clonidine and fracture risk in children with attention-deficit hyperactivity disorder: multicentre electronic health record evidence

Background Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience elevated injury rates. Clonidine is commonly prescribed for ADHD, yet its association with fracture risk has not been well defined.

Methods Retrospective study using TriNetX. Patients (6-18 years) with ADHD (ICD-10-CM F90) were classified as clonidine-exposed if they had a prescription within 6 months before or on the ADHD index date; controls had no clonidine exposure. Matching yielded 73,141 patients per cohort. Follow-up began 1 day after the index and extended through available records, up to 20 years. Primary outcomes were distal radius (S52.5), clavicle (S42.0), and supracondylar humerus (S42.41) fractures.

Results After matching, 133,630 patients were included (66,815 per cohort). Thirty-day postoperative infection occurred in 1.03% (690/66,815) of SSRI users versus 1.44% (963/66,815) of non-SSRI controls (risk difference-0.41 percentage points; RR 0.71, 95% CI 0.64-0.78; HR 0.69, 95% CI 0.62-0.76; p<0.001). No statistically significant differences were observed for delayed wound healing, wound dehiscence, hematoma, seroma, nausea, or sepsis.

Conclusions Clonidine exposure was associated with lower risks of distal radius, clavicle, and supracondylar humerus fractures. Findings support prospective studies to confirm causality and explore mechanisms.