Prevalence of bone fractures among children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis

Hoda Seens; Shirin Modarresi; Joy C MacDermid; David M Walton; Ruby Grewal

doi:10.1186/s12887-021-02821-x

Prevalence of bone fractures among children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis

BMC Pediatr. 2021 Aug 19;21(1):354. doi: 10.1186/s12887-021-02821-x.

Authors

Hoda Seens^{1

2}, Shirin Modarresi^{3

4}, Joy C MacDermid^{3

4

5}, David M Walton^{3

4}, Ruby Grewal^{5

6}

Affiliations

¹ Health and Rehabilitation Sciences, Western University, London, ON, Canada. hmalakou@uwo.ca.
² Windsor University School of Medicine, Cayon, Saint Kitts and Nevis. hmalakou@uwo.ca.
³ Health and Rehabilitation Sciences, Western University, London, ON, Canada.
⁴ School of Physical Therapy, Western University, London, ON, Canada.
⁵ Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada.
⁶ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is a significant neurodevelopment disorder among children and adolescents, with 5 % prevalence. Bone fractures account for 25 % of accidents and injuries among all children and adolescents. Considering the characteristics of inattention, hyperactivity, and impulsivity in children with ADHD, it is critical to examine bone fractures among these children. The objective of our meta-analysis was to determine the prevalence of bone fractures among children and adolescents with ADHD.

Methods: We completed a systematic review and meta-analysis using an electronic search of the following databases: CINAHL, EMBASE, PsycINFO, PubMed, and Scopus. The search terms used were: "attention deficit hyperactivity disorder OR attention deficit disorder" and "bone fracture*." We included studies examining patients 18 years or younger who were diagnosed with ADHD and tracked (prospectively or retrospectively) for five or more years. Effect size (es), using a random effects model, was calculated. We registered the review protocol with PROSPERO (CRD42019119527).

Results: From 445 records retrieved, 31 full text articles were reviewed and 5 articles met inclusion criteria for meta-analysis. The summary es revealed the prevalence of bone fractures among children and adolescents with ADHD to be 4.83 % (95 % CI: 3.07-6.58 %). The location of bone fractures, using a subset of data, showed a distribution of 69.62 %, 22.85 %, and 7.53 % in the upper limbs, lower limbs, and other anatomical regions, respectively. Another subset of studies revealed a 2.55-fold increase in the prevalence of fractures among the children with ADHD compared to their counterparts.

Conclusions: Awareness of these findings is critical to physicians, parents, and policy makers to create safe environments and provide supports in order to optimize the health and safety of children and adolescents with ADHD.

Keywords: Accident; Adolescents; Attention-deficit/hyperactivity disorder; Bone fracture; Children; Injury.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity* / epidemiology
Child
Fractures, Bone* / epidemiology
Fractures, Bone* / etiology
Humans
Parents
Prevalence
Retrospective Studies