Long-term clonidine and fracture risk in children with attention-deficit hyperactivity disorder: multicentre electronic health record evidence
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262016Keywords:
Clonidine, ADHD, Pediatric fractures, Distal radius, Supracondylar humerusAbstract
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.
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