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Turkish Journal of Medical Sciences

Abstract

Background/aim: Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized not only for its behavioural and cognitive challenges but also for its potential implications in physical health, particularly injury risk. This study aimed to investigate the incidence of extremity fractures among children and adolescents diagnosed with ADHD and to evaluate the influence of demographic, clinical, and pharmacological variables—including ADHD subtypes and medication types—on fracture risk

Materials and Methods: This retrospective cross-sectional study included 754 children and adolescents aged 6–18 years who were diagnosed with ADHD according to DSM-5 criteria. Data were collected from electronic health records at a tertiary referral hospital. Variables analyzed included age, sex, ADHD subtype, IQ level, pharmacological treatment status (methylphenidate or atomoxetine), comorbid psychiatric and medical conditions, and fracture history confirmed by clinical and radiological evidence. Binary logistic regression analysis was conducted to identify independent predictors of fracture risk.

Results: The overall incidence of extremity fractures was 15%, with 69% occurring in the upper extremities. Children using ADHD medication had significantly lower fracture rates (9.7%) compared to untreated peers (32.6%, p < 0.001). Logistic regression revealed that both methylphenidate (OR = 0.396) and atomoxetine (OR = 0.138) were associated with reduced fracture risk. The inattentive subtype also demonstrated a protective effect. Other factors, such as age, sex, IQ, and comorbidities, were not significantly associated with fracture incidence.

Conclusions: This study highlights a notable reduction in extremity fracture risk among children with ADHD receiving pharmacological treatment, suggesting a possible protective role of stimulant and non-stimulant medications. Subtype-specific risk profiles further emphasize the importance of personalized approaches in ADHD management strategies.

Author ORCID Identifier

YÜKSEL SÜMEYRA NARALAN: 0000-0002-7788-5711

ESRA DEMİREL: 0000-0002-8468-6286

DOI

10.55730/1300-0144.6047

Keywords

ADHD, extremity fracture, children, methylphenidate, atomoxetine, physical health

First Page

940

Last Page

948

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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