Publication:

Adderall use and the risk of fractures in the pediatric population: a retrospective cohort study

Background Children with attention-deficit/hyperactivity disorder (ADHD) experience higher injury rates than their peers, but the effect of stimulant therapy on fracture risk remains uncertain. To evaluate the association between amphetamine exposure and incident fractures of the distal radius, supracondylar humerus and clavicle in youth with ADHD.

Methods Retrospective cohort study using the TriNetX global collaborative network. Patients aged 6–18 years with ADHD (ICD-10-CM F90) were classified as amphetamine-exposed (prescribed dextroamphetamine or amphetamine within six months of index) or unexposed. Outcomes were new distal radius (S52.5), supracondylar humerus (S42.41) and clavicle (S42.0) fractures. Incidence, risk ratios and hazard ratios were estimated with Kaplan–Meier and Cox models.

Results After matching (n=226,620; 113,310 per cohort), amphetamine exposure was associated with significantly lower 30-day fracture risk. Distal radius fractures occurred in 0.44% of exposed vs 0.72% unexposed (RD −0.28%, RR 0.61, 95% CI 0.55–0.69, HR 0.46, 95% CI 0.41–0.51, p<0.001). Supracondylar fractures occurred in 0.04% vs 0.08% (RD −0.04%, RR 0.51, 95% CI 0.36–0.72, HR 0.41, 95% CI 0.29–0.57, p<0.001). Clavicle fracture risk was similar between cohorts (0.18% vs 0.21%, RD−0.03%, RR 0.76, 95% CI 0.63–0.93, p=0.084), although HR remained significant (HR 0.63, 95% CI 0.52–0.76, p<0.001).

Conclusions Among children and adolescents with ADHD, amphetamine exposure was associated with significantly lower fracture incidence and hazard for distal radius, supracondylar humerus and clavicle injuries. These findings suggest stimulant treatment may reduce specific orthopaedic injuries and merit further investigation.