January 30, 2024
Some animal studies and laboratory experiments have suggested that methylphenidate, the most widely prescribed pharmaceutical to treat ADHD, may weaken bones. On the other hand, other studies have indicated that methylphenidate is associated with lower risk of injury.
What, then, is the overall effect?
The Hong Kong Hospital Authority is the sole public health provider for the city’s 7.3 million residents. Using the Clinical Data Analysis and Reporting System, the Authority’s electronic database, an international study team set out to explore this question.
Among 43,841 individuals with ADHD medication, the team identified 2,023 children and youths 5 through 24 years old with both methylphenidate prescription and a fracture between January 2001 and December 2020.
In the six months following prescription, individuals were found to be roughly 40% less likely to be treated for a fracture than in the six months prior to prescription. The same held true when comparing the period 7 to 12 months after prescription with the six months prior to prescription.
As a control, the team also looked at the effect of methylphenidate prescription on a completely unrelated condition – diseases of the esophagus, stomach, and duodenum.
In this case, there was absolutely no difference in disease incidence for equal periods of time before and after initiation of methylphenidate treatment.
The team concluded, “for all-cause fractures, the results of the … within-individual comparison demonstrated that the use of methylphenidate is associated with lower risk … compared with the … period before the treatment initiation.”
Le Gao, Kenneth K C Man, Min Fan, Grace M Q Ge, Wallis C Y Lau, Ching-Lung Cheung, David Coghill, Patrick Ip, Kirstie H T W Wong, and Ian C K Wong, “Treatment with methylphenidate and the risk of fractures among children and young people: A systematic review and self-controlled case series study,” British Journal of Clinical Pharmacology (2023) 89:2519-2528, https://doi.org/10.1111/bcp.15714.