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PLoS One. 2017 Mar 15;12(3):e0173762. doi: 10.1371/journal.pone.0173762. eCollection 2017.

The association between methylphenidate treatment and the risk for fracture among young ADHD patients: A nationwide population-based study in Taiwan.

Chen VC1,2, Yang YH3,4,5,6, Liao YT7,8, Kuo TY4, Liang HY2,9, Huang KY10, Huang YC11, Lee Y12, McIntyre RS12,13, Lin TC6,7.

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Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan.
Department of Medicine, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.
Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan.
Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi.
Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada.
Department of Psychiatry, University of Toronto, Toronto, Canada.


Attention-deficit hyperactivity disorder (ADHD) is associated with higher risk for fracture. Whether the medical treatment for ADHD would mitigate the risk remains unclear. In this study, we sought to investigate the effect of methylphenidate treatment on risk for fracture, as well the moderational role of treatment duration on the risk of fracture, in a large national sample. Cases less than 18 years old were identified from Taiwan's National Health Insurance Research Database with a new primary diagnosis of ADHD (ICD-9:314) between 1996 and 2013. A total of 6201 cases with ADHD were included as the study cohort. The cases were divided into 3 groups according to the duration of methylphenidate treatment (0, 1-180, and more than 180 days). All groups were followed until the end of 2013 for first diagnoses of fracture (ICD-9 codes 800 to 829). Cox proportional hazards models were applied. Compared to the group without methylphenidate treatment, the risk for fracture was lower among the group treated for more than 180 days. The adjusted hazard ratio was 0.77 (95% Confidence interval: 0.63-0.94). The groups treated for 180 days or fewer had no significant difference in the risk for fracture. In conclusion, methylphenidate treatment was associated with lower risk for fracture among ADHD patients. The association was evident only in the cohort treated for more than 180 days.

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