{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:55:19Z","timestamp":1780534519616,"version":"3.54.1"},"reference-count":52,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Animal studies suggest that methylphenidate treatment for around 3\u2009months may lead to less mineralized and weaker appendicular bones. A systematic review was conducted to summarize the evidence from observational studies, and a self\u2010controlled case series study was used to compare the risk before and after treatment initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Literature search was conducted using PubMed, Embase and the Cochrane Library to identify observational studies on methylphenidate and fractures. We also conducted a self\u2010controlled case series study with individuals aged 5\u201324\u2009years who received methylphenidate treatment and experienced fractures from 2001 to 2020 in Hong Kong. Incidence rate ratios and 95% confidence intervals were calculated by comparing the incidence rate in the methylphenidate\u2010exposed period compared with nonexposed period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six cohort studies and 2 case\u2013control studies were included in the systematic review. For all\u2010cause fractures, studies found a 39\u201374% lower risk in treated\u2010attention deficit hyperactivity disorder (ADHD) group compared with untreated ADHD but no difference between stimulants and nonstimulants. Differences between sexes and treatment duration were also found\u2014significant results were shown in males and those with longer treatment duration. Among 43\u2009841 individuals with ADHD medication before the year 2020, 2023 were included in the self\u2010controlled case series analysis. The risks of fractures were lower by 32\u201341% in different treatment periods when compared with 6\u2009months before treatment initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Methylphenidate treatment may lower the risk of all\u2010cause fractures from both study designs; however, further evidence is needed about the treatment duration and sex effect. Conclusions on stress fractures are not yet established, and further research is required.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.15714","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T03:24:26Z","timestamp":1678850666000},"page":"2519-2528","source":"Crossref","is-referenced-by-count":6,"title":["Treatment with methylphenidate and the risk of fractures among children and young people: A systematic review and self\u2010controlled case series study"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9349-6599","authenticated-orcid":false,"given":"Le","family":"Gao","sequence":"first","affiliation":[{"name":"Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong Special Administrative Region China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth K. 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