{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:21:54Z","timestamp":1778761314169,"version":"3.51.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:p>The aim of this study was to investigate the risk of fracture and the difference between sexes from a nationwide database of fracture risk among children aged 4\u201317 years with or without attention deficit hyperactivity disorder (ADHD, ICD-9-CD codes 314). The Longitudinal Health Insurance Database (LHID 2000) was used to analyze fracture characteristics of children from the National Health Insurance that covered 96.1% of the Taiwanese population (<jats:italic toggle=\"yes\">N<\/jats:italic>=21.4 million). A total of 7200 ADHD children aged between 4 and 17 years whose diagnosis had been confirmed in at least three outpatient clinics between 1 January 2000 and 31 December 2009 were included, and a cohort of 36\u2009000 children without ADHD matched for age, sex, and urbanization was recruited for analysis. The incidence rate of fractures in ADHD children was 21.0 (95% confidence interval=19.4\u201322.7) per 1000 person-years, significantly (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt;0.001) higher than 15.0 (95% confidence interval=14.4\u201315.6) in non-ADHDs. After adjusting by age, sex, urbanization level, and geographic region, the statistically significant (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt;0.001) hazard ratios (HR) of fracture for ADHD children compared with non-ADHD children included 1.62 in girls and 1.38 in boys, 1.53 in the skull, neck, and trunk (ICD-9-CM 800\u2013809), 1.28 in the upper extremity (ICD-9-CM 810\u2013819), and 1.84 in the lower extremity (ICD-9-CM 820\u2013829). The HR also (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt;0.001) increased significantly in all age groups, including 1.35 in 4\u20136, 1.37 in 7\u20139, and 1.54 in 10\u201317 years. ADHD should be listed among risk factors of children\u2019s fractures in each sex, all age groups, and all body areas that the parents, teachers, caregivers of ADHD children, and pediatric orthopedists should be aware of. Besides, ADHD girls were more affected than ADHD boys, especially after 10 years of age, whereas the adjusted HR was the highest in the lower extremities. Nationwide analysis matched for age and sex showed that ADHD should be considered the risk factor of children\u2019s fracture, especially for girls older than 10 years of age.<\/jats:p>","DOI":"10.1097\/bpb.0000000000000243","type":"journal-article","created":{"date-parts":[[2015,10,30]],"date-time":"2015-10-30T10:50:34Z","timestamp":1446202234000},"page":"369-374","source":"Crossref","is-referenced-by-count":27,"title":["Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: a nationwide matched study"],"prefix":"10.1097","volume":"25","author":[{"given":"Nai-Wen","family":"Guo","sequence":"first","affiliation":[{"name":"Institute of Behavior Medicine, College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Wei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Tung","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Lun","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsung-Hsueh","family":"Lu","sequence":"additional","affiliation":[{"name":"NCKU Research Center for Health Data and Department of Public Health, National Cheng Kung University, Tainan City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chii-Jeng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1159\/000103007","article-title":"Risk factors for fractures in normally active children and adolescents","volume":"51","author":"Goulding","year":"2007","journal-title":"Med Sport Sci"},{"key":"R2-20230828","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1359\/jbmr.040902","article-title":"Epidemiology of childhood fractures in Britain: a study using the general practice research database","volume":"19","author":"Cooper","year":"2004","journal-title":"J Bone Miner Res"},{"key":"R3-20230828","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s11914-014-0226-z","article-title":"Underweight, overweight, and pediatric bone fragility: impact and management","volume":"12","author":"Bialo","year":"2014","journal-title":"Curr Osteoporos Rep"},{"key":"R4-20230828","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s00223-004-0274-y","article-title":"Soft drink and milk consumption, physical activity, bone mass, and upper limb fractures in children: a population-based case-control study","volume":"75","author":"Ma","year":"2004","journal-title":"Calcif Tissue Int"},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1359\/jbmr.080303","article-title":"Vigorous physical activity increases fracture risk in children irrespective of bone mass: a prospective study of the independent risk factors for fractures in healthy children","volume":"23","author":"Clark","year":"2008","journal-title":"J Bone Miner Res"},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.2106\/JBJS.L.00369","article-title":"Fractures in children: epidemiology and activity-specific fracture rates","volume":"95","author":"Randsborg","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S0140-6736(97)11450-7","article-title":"Attention-deficit hyperactivity disorder and hyperkinetic disorder","volume":"351","author":"Swanson","year":"1998","journal-title":"Lancet"},{"issue":"Suppl 1","key":"R8-20230828","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00787-008-1007-y","article-title":"How often do children meet ICD-10\/DSM-IV criteria of attention deficit-\/hyperactivity disorder and hyperkinetic disorder? 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